New Podcast: Hospice Quality Reporting

Originally posted on 

A new episode of NHPCO’s Podcast looks at quality reporting with a focus on requirements coming into play for hospice providers.

Quality has long been about what you “should” be doing but now we’ve moved into an era of what you “have” to be doing. And now more than ever there needs to be a close collaboration between compliance and quality. The most immediate quality requirements must be in place in less than a month.

L to R: Carol Spence and Jennifer Kennedy get you up to speed on Quality Reporting.

In this episode of NHPCO’s Podcast, “Hospice Quality Reporting… Ready, Set, Go,” listeners will hear NHPCO’s Vice President of Research and Quality Carol Spence and Senior Director of Regulatory and Quality Jennifer Kennedy discuss the upcoming quality requirements and learn ways that providers can prepare.

HQRP Requirements

The Center for Medicare and Medicaid Services (CMS) determines the quality measures that hospices must utilize and the processes hospices must use to submit data for those measures. Hospices that fail to comply with HQRP requirements will incur a 2 percentage point reduction to the market basket percentage increase for the corresponding fiscal year.

Hospices are required to comply with requirements for two HQRP program components that comprise the data sources for the measures:

  • Hospice Item Set (HIS)… A component of the HQRP for the FY 2016 APU and subsequent years. HIS is a patient level data collection tool developed by CMS.  Hospices are required to submit an HIS-­Admission record and an HIS­-Discharge record for each patient.
  • CAHPS® Hospice Survey… A component of the HQRP for the FY 2017 APU and subsequent years. CAHPS Hospice is a post­death family caregiver survey developed by CMS for the assessment of patient and family experiences with hospice care.

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What the Obamacare Replacement Bill Means to the Hospice Provider

HAN is happy to be hosting Dr. Noam Stern, a Fellow in Pediatric Palliative Care at Akron Children’s Hospital in Akron, Ohio. During his time with us, Dr. Stern will be learning about the intersection of clinical practice and policy-making, with an eye towards improving advocacy for pediatric palliative care. As a part of his experience, he will be writing the occasional guest blog post. We threw him into the deep water right away, and asked him to give us a provider-focused analysis of the proposed Obamacare Replacement Bill just introduced in Congress:

On Monday, House Republicans introduced the American Health Care Act (AHCA), their first draft replacement to the Affordable Care Act (ACA). What would the AHCA change for the hospice provider? Let’s break it down.

Dr. Noam Stern, Pediatric Palliative Care Fellow at Akron Children’s Hospital.

The good news is that there is little in the bill that would directly affect hospices.  In fact, the words “hospice” and “palliative” are not in the bill at all. Of particular interest to our community, the bill leaves in place a provision allowing Medicaid and CHIP programs to cover concurrent hospice and curative care for children.

Further, the majority of hospice patients have insurance through Medicare and the AHCA makes no changes to Medicare eligibility, so this patient pool would not be affected.  In short, if the AHCA is passed, there would be little anticipated changes in day-to-day hospice services.

What is addressed in the bill is the commercial insurance marketplace. In 2014, 6.9% of hospice patients had managed care or private insurance and 5% utilized Medicaid hospice benefits, and these patient pools could change.

It is unclear how the AHCA would change the number of Americans with private insurance. Under the ACA, the rates insurance companies charge to individuals were constrained such that the most expensive plan could be no more than three times the cost of the cheapest plan offered by that company. Under the AHCA the ratio goes from 1:3 to 1:5 but also has language allowing states to change the ratio as they see fit. The income-based subsidies provided under the ACA would also be replaced with credits based more on age than income. The mandates for employers to provide insurance and for individuals to obtain insurance or have a tax penalty under the ACA would be replaced by incentivizing continued coverage through increasing private insurance rates by 30% for those that have gone without insurance in the year prior. It is hard at this point to estimate how these changes will impact private insurance rates.

Additionally, there may be large discrepancies on what is covered between private plans and some may not have a hospice benefit.

The largest change would be for the Medicaid population. Thirty-one states and the District of Columbia have expanded Medicaid to include Americans up to 138% of the federal poverty line.  The AHCA would freeze the expansion in 2020 and likely result in states reducing eligibility (6 states and DC would automatically revert to pre-expansion eligibility based on how expansion was passed in those states).  For children, eligibility in all states was raised to 133% of the federal poverty line and the AHCA reverts this back to the federal poverty line.

The AHCA also changes the way the federal government pays for Medicaid, changing from a percentage of the state’s total cost to a per-participant rate starting at 85% of what the state spent in 2015. This may not affect hospice programs directly, but as the hospice benefit in Medicaid is optional, it is possible that some states could choose to not offer the benefit under this new payment scheme.

So in summary, the vast majority of hospice patients would be unaffected by the AHCA.  Patients covered by Medicaid and private insurance might be affected, but it’s too early to tell how these changes would affect hospice operations in the long run.

And it’s important to remember that  the AHCA is only a first draft at a replacement for the ACA. The bill will likely change as it moves through the legislative process.  As it is debated and revised,  NHPCO will continue to advocate for you and the interests of the patients you serve.

A Message from Edo Banach

March 3, 2017

Dear Colleagues,

I’ve completed my first official week as President and CEO at NHPCO.  I am honored to lead the organization at this important time of change, and look forward to working together.

Over the next several weeks and months, I will be learning more about your needs and the ways we can best serve you in the important work you do in your communities every single day.  I look forward to telling your stories to consumers, caregivers and policy-makers and expanding awareness of your dedication and skill. Together, we will build on the strong foundation of hospice and palliative care to grow innovative and compassionate care programs that will serve all in need.

As I begin my tenure working with you and for you at NHPCO, National Hospice Foundation, and the Hospice Action Network, it seems fitting to reflect on the guiding values of this organization:

  • Service… engaging with you, our members and constituents, is at the heart of all that we do.
  • Respect and Collaboration… valuing the expertise, skills and contributions from the field and fostering partnerships and relationships with all our stakeholders is vital to future success.
  • Excellence… exceeding the expectations of our members and embracing change and innovation will allow us to continually improve and grow in a manner that will allow us to embrace opportunities.
  • Stewardship… managing resources with the highest ethical and fiscal standards will ensure accountability of your investment within NHPCO and foster integrity throughout our organization.

Please know that I take these values seriously and they will serve me and the entire team as we work together towards the bright future I see ahead of us all. A future that will not be without challenges, certainly, but I know that we can meet these challenges together as we strive to provide the highest quality care for those in need of our services and care.

I’ve been fortunate to meet a number of NHPCO members during my first week and I know this will continue.  I look forward to meeting you at our upcoming Management and Leadership Conferenceon May 1 – 3, 2017 at the Washington Hilton. If you have not already registered, I hope you’ll consider joining us. This will be a great opportunity to get to know each other better.

Please don’t hesitate to reach out to me at to share your thoughts, insights, and suggestions about the ways we can best serve you and work together.

Respectfully yours,


Edo Banach, JD
President and CEO

February Hospice News Update

We are through with the coldest months of the year, and in DC at least, spring is on its way! As the politicians emerge from their winter hibernation, stay up-to-date with the latest in hospice and palliative care news:

News from Capitol Hill

GA Congressman Tom Price is confirmed as head of HHS

Senate Finance Committee holds confirmation hearing for CMS Administrator nominee Seema Verma

Send This Letter to your Members of Congress, and help educate them on the role of hospice and palliative care in their districts! (Thank you to everyone who has already sent letters! If you send a letter, please let me know!)

Check out the Town Hall Project to learn when your Members of Congress are holding local events, and then go meet them!

Regulatory Watch

Update on Medicare Care Choices Model

NHPCO, Pew Research,  and other organizations send policy recommendations letter to Secretary Price of HHS


A Look Ahead: 

Join HAN and NHPCO at Advocacy at MLC on May 3, to learn the latest goings-on in Washington and meet with your Members of Congress. The event is free for MLC attendees. Learn more here.

Mark your calendars for the 2017 Advocacy Intensive! July 17-18 in Washington, DC! Registration will open in May.

National Healthcare Decisions Day: We are looking for programs to host NHDD events the week of April 16-22, and invite their Members of Congress to attend! We’d like to make sure at least ten Members of Congress attend NHDD events this year, the tenth anniversary of NHDD. Please email me at if you are having an event and would like to invite a Member of Congress! (Yes it is ok if your event isn’t exactly during that week, as long as it is NHDD related). Check out the NHPCO NHDD Resources page for outreach materials.  We will continue to update the resources as we get closer to the date.

Good Reads:

How to Increase Use of Palliative Care in Medicare

First, Sex Ed. Then, Death Ed.

Music Therapy Helps Dying Patients

How Hospice Changes the Way We Die

VP Pence Meets with Right To Try Advocates

Facebook Extends Bereavement Leave for Employees

I get asked frequently if people can post our blog articles to their social media. Yes, please do! I am happy to provide content, especially to those of you who are one-person Marketing/Communications/Social Media/Fundraising/Volunteer Managers!

For our Advocates: Free Webinar from our friends at the Congressional Management Foundation, Backstage Pass: Behind the Scenes of Congressional Decision Making, March 21, 2017 1-2pm EDT.

And finally, Edo is in the house! Our new CEO, Edo Banack, has officially taken residence in the NHPCO corner office. Stay tuned to our social media to see a message from him early next week!