In The News

Focus Group Study: 30% Believe Hospice Intentionally Hastens Death

Hospice News / By Holly Vossel

About 30% of participants in a recent study said they believe that “hospice intentionally hastens death and the dying process.”

The data appeared in a recently developed evidence-based serious illness messaging toolkit from the MessageLab Serious Illness Messaging Project. The toolkit identifies new approaches for hospice and palliative care providers to break down barriers of public misperception and apprehension of their services.

One key consideration in hospices’ public messaging is that, in today’s media and technology climate, consumers access information quickly and in small doses. This means hospices have to achieve more with less in their efforts to reach consumers, according to Dr. Tony Back, primary investigator at the MessageLab Serious Illness Messaging Project.

“We have to stop trying to confront people about dying and expecting them to accept that in some kind of social media or video post. It’s just not going to happen,” Back told Hospice News. “We’re not gaining a new consumer audience or increasing public awareness in hospice and palliative. We’re not improving levels of misconception that exist about our field. There are messaging principles we can employ to improve how hospices introduce their work to the public.”

Back is also a professor of medicine and palliative care physician at the University of Washington in Seattle, co-director at the Cambia Palliative Care Center of Excellence, and co-founder of VitalTalk.

Public misunderstandings about hospice and palliative care have long-plagued the field. Hospice providers have continuously sought marketing and outreach strategies that demonstrate the benefits and value of their services to patients and families.

But many hospices’ public messaging approaches fall short of what’s needed to dispel myths, alleviate fears, and improve awareness, according to researchers.

MessageLab researchers reviewed a wide variety of public messaging, designs and other marketing components and analytics in the hospice and palliative care space to uncover common trends and issues. Armed with this information, they developed guidelines for improved communication.

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Hospice Leaders Call for Overhaul of Regulation

Hospice News / By Holly Vossell

Hospice providers are calling on regulators to change their approaches to enforcement due to the cost burden and the unpredictable nature of the dying process.

The U.S. Centers for Medicare & Medicaid Services (CMS) and the U.S Department of Health & Human Services Office of the Inspector General (OIG) have been cracking down on the industry with a heavy focus on patient eligibility and longer lengths of stay.

This has put hospices in a constant state of defense in today’s current regulatory climate, according to Craig Dresang, CEO of California-based YoloCares. 

“The reality is that we are in this posture of always being prepared to react and respond to the current auditing environment,” Dresang told Hospice News at the ELEVATE conference in Chicago. “We have to come together as providers with a fire and energy to insist on change from CMS, because we’re tired of playing a ‘gotcha game’ with the federal government. They’ve made the dying process a game of dates and deaths.”

Current rubrics for eligibility and length of stay are difficult to align with patients’ actual experiences at the end of life. A six-month terminal prognosis, for example, typically represents clinicians’ best guesses as to how long the patient will survive. But those predictions are not hard and fast.

This degree of unpredictability can make compliance challenging for providers, Dresang indicated.

Hospices also encounter variations in auditing practices that can impact perceptions of the provider’s performance, according to Alisa Gerke, executive director of Wisconsin-based Unity Hospice & Palliative Care.

“Some markets are set up whereby the auditor is incentivized in that the more issues they find, the bigger their paycheck,” Gerke told Hospice News during the conference. “We have to evolve and evaluate our practices and processes. We can’t afford not to have compliance more organized.”

The costs associated with these audits and other regulatory actions are high, according to Gerke.

In some cases, hospices can sometimes spend more on legal fees than they would make if the Medicare claims in question are ultimately paid, she explained.

To reduce the impact internally, hospice leaders need a system in place to identify high- and low-risk processes in terms of compliance, Gerke said. . .

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Major Revisions Made to Home Office Cost Report

The Health Group

The U.S. Centers for Medicare & Medicaid Services has released Home Office Cost Statement, Form CMS-287-22 (“Home Office Cost Report”).  R1P248i | CMS

The new Home Office Cost Report (CMS-287-22) is effective for cost reporting periods beginning on or after October 1, 2022, and implements an electronic reporting requirement, which was not previously required.

The Home Office Cost Report, as modified, renames many of the worksheets to be more consistent with other cost report types and incorporates new reporting data.

A home office is an entity that provides centralized management and administrative services to the individual members of a chain organization.  A chain organization consists of two (2) or more Medicare-certified providers or at least one (1) provider and any other non-provider business.  To the extent that a Home Office furnishes services to a provider, the reasonable costs of such services are included in the provider’s cost report, as determined by the Home Office Cost Report.  Home office costs are assigned to all supported activities through direct assignment, functional allocations (based on established statistical basis), or pooled allocations.

The revised cost report, which will be required to be submitted electronically, incorporates Level 1 edits.  Failure to correct a Level 1 edit will result in the inability to submit the Home Office Cost Report electronically.  If claiming home office costs, a provider must ensure they are submitting an acceptable Home Office Cost Report to the Home Office’s Medicare Administrative Contractor (“MAC”).  Also, a copy of the Home Office Cost Report must be sent to each of the MACs for the chain providers.  If submitted electronically through the Medicare Cost Report e-Filing (“MCReF”) portal, we expect that all MACs are appropriately notified.  If, however, the Home Office Cost Report is filed via CD or flash drive directly with the Home Office’s MAC,  a copy of the Home Office Cost Report should be submitted to other provider servicing MACs as an attachment to the provider’s cost report submission and identified as a copy.

Effective for cost reporting periods beginning on or after 10/1/2018, for providers claiming costs on their cost report that are allocated from a home office or chain organization with the same fiscal year end, a cost report will be rejected for lack of supporting documentation if the home office or chain organization has not completed and submitted to the chain provider’s contractor a Home Office Cost Statement that corresponds to the amounts allocated from the home office or chain organization to the provider’s cost report. 

We recommend that all providers who submit Home Office Cost Reports review the revised report to ensure that data currently being accumulated is sufficient to meet the future reporting needs.  We will report additional information regarding the revised Home Office Cost Report as we further assess the details.

 

Criminal Conviction in “No Poach” Case

It may be tempting for providers to enter so-called “no poaching agreements” due to staffing shortages and a lack of capable managers, including marketing staff, which continue to plague the healthcare industry. These agreements often involve conspiring with rivals not to solicit or hire each other’s employees. Don’t do it!

According to the Department of Justice (DOJ), these agreements may produce artificial suppression of employees’ compensation and may violate the federal Sherman Act. Violations of the Sherman Act could result in criminal prosecution or civil enforcement actions. There has been a dramatic increase in both types of action under the Sherman Act based on “no-poach” agreements. 

The Department of Justice (DOJ) has now succeeded in criminal prosecution of this type of arrangement in United States v. Hee et al [Case No. 2:21-cr-00098, D. Nev; (October 27, 2022)]. In this case, the DOJ charged VDA, a health staffing company, and Ryan Hee, a regional manager for VDA, with violation of Section 1 of the Sherman Act by conspiring with another company to refrain from poaching each other’s nurses and to fix their wages. As a result of a guilty plea, VDA was ordered to pay $139,000 as a criminal fine and restitution.

VDA was one of two primary providers of contract nursing services to the Clark County School District from October of 2016 until July of 2017. During this time, VDA participated in a conspiracy with another contract health care staffing company to allocate nurses and fix their wages. The agreement in question lasted for less than nine months, after which VDA was sold. 

In addition, VDA has pointed out that the no poach agreement involved only a single telephone conversation and one email message between one of VDA’s employees and a competitor’s employee. This conversation and email message both occurred on the same day six years ago immediately after the Department of Justice (DOJ) published its Antitrust Guidance for HR Professionals.

Based upon the above, it clearly doesn’t take much to produce a criminal conviction in this area.  Although this case involved a “no poach” agreement, it certainly signals that the DOJ is serious about antitrust enforcement in general. There are three other labor market criminal cases brought by the DOJ that are still pending. Stay tuned for more developments in this area.

©2022 Elizabeth E. Hogue, Esq. All rights reserved.

No portion of this material may be reproduced in any form without the advance written permission of the author.

 

RSV Updates

Healthcare Ready

National pediatric bed capacity is the scarcest it has been in two years, with 71 percent of US pediatric hospital beds reported as filled. Since October 21, hospitals in the following states and localities have seen rising pediatric surge: Rhode Island, Washington, Colorado, Texas, Ohio, Louisiana, New Jersey, Massachusetts, Connecticut, Maryland, Virginia, and Washington, DC. The increase in pediatric hospital admissions is largely due to a rise in respiratory-related illnesses, such as respiratory syncytial virus (RSV), enterovirus, and rhinovirus (RSV being the most critical illness for which children are currently being admitted to the hospital).  

We will be producing a respiratory syncytial virus (RSV) situation report weekly for the foreseeable future as RSV has been surging recently within the pediatric community.  

Impact to Healthcare

The concurrence of rising RSV cases and preparation for the upcoming flu season is straining pediatric hospitals across the US. Connecticut Children’s Medical Center, Hartford, Connecticut, is working with FEMA to set up medical tents on the hospital lawn because of the increased need for beds. 

Children’s hospitals in DC, Virginia, and Baltimore are reporting full capacity of available pediatric beds. Based on the experiences of states that are already impacted by the pediatric respiratory illness surges, current trends indicate a likelihood that more states will be impacted. 

Vulnerable Populations
Infants younger than six months, especially those who are premature, are at and especially high risk for contracting RSV and are affected by typical symptoms of this illness. Excessive medical surge caused by RSV and other respiratory diseases may threaten the health outcomes of children, especially infants if the medical surge situation worsens and crisis standards of care are implemented. 

Treatments for RSV
Prevention and preparedness will be essential to avoid worsening surge conditions for infants, children, and adolescents. Children and young adults – who are eligible – are encouraged to get flu shots prior to flu season, especially because there is no vaccine for RSV, yet. This will help prevent seasonal cases of the flu and lessen the risk of increased hospitalizations due to other respiratory illnesses. Fewer flu-related hospitalizations will ensure greater bed capacity in pediatric hospitals for the treatment of other illnesses. 

A monoclonal antibody therapy called palivizumab is available to prevent severe RSV illness in certain infants and children who are at high risk for severe disease. It cannot cure or treat children who are already suffering from serious cases of RSV; it is a preventative treatment. 

 
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