What to Expect in 2018

It’s the second week of 2018 and both the House and Senate are back in action!  2018 is going to be a very busy year, and one of the first orders of business on the legislative calendar is completion of the FY 2018 budget.  Lawmakers must finalize the FY 2018 budget by Jan 19th or enact another continuing resolution to avoid a government shutdown.

Midterm elections are in November and all 435 seats in the United States House of Representatives and 33 of the 100 seats in the United States Senate are up for re-election.  It may be difficult to pass any significant legislation with control of the house and senate hanging in the balance, but NHPCO will continue to make the voices of hospice organizations heard on Capitol Hill and ensure that our priorities are protected.

Congress is also currently in the process of negotiating a package of Medicare-related legislation known as “Medicare extenders.”  Specifically, NHPCO is pushing for the inclusion of the Rural Access to Hospice Act in the Medicare Extenders Package.  This legislation would increase access to hospice care, especially in under served communities, by allowing clinicians at Rural Health Centers and Federally Qualified Health Centers to serve as the hospice attending physician.  YOU – YES YOU- can support the Rural Access to Hospice Act by contacting your member of Congress today!

Other important healthcare legislation NHPCO is actively supporting and working to bring to the forefront of the healthcare conversation this year include the Patient Choice and Quality Care Act (PCQCA), the Palliative Care and Hospice and Education and Training Act (PCHETA), and the Medicare Patient Access to Hospice Act.

So that’s about it for now! Check back regularly as we’ll be providing a more detailed video and podcast on what the hospice community can expect from NHPCO in 2018.

NHPCO Welcomes New Fullbright Fellow, Lenka Vanova!

Hello everyone, my name is Lenka Vanova and I come to NHPCO as a Fulbright Fellow for the next four months. My educational background is in humanities and cultural management, which I did for more than five years, organizing exhibitions and other cultural events. At the same time, however, I was interested in the ways architecture and design can help people to age in place (and thus lessen the burden on public finance) and devoted my Ph.D. thesis to this topic. After graduation I found a position combining all of my various interests and qualifications and I started to work for a major hospice (a mobile palliative care unit) in Prague, called Cesta domu, as a public affairs coordinator.

Cesta domu is one of the oldest and largest hospices in the Czech Republic and besides providing direct care services to patients, we publish books, run the only Czech public library specialized in palliative care and last but not least, advocate for hospices and palliative care on the national level. And advocacy is what I want to learn here at the NHPCO as I admire the consistent work and comprehensive tools and support it provides to the hospice community. In the Czech Republic, hospice care is only being started to be covered by the public health insurance (as of January 1, 2018, in fact). While this was a major success, plenty is yet to be done. I believe that with an experience from NHPCO, I will be able to help advocate for US policies, but then take that experience home to help the Czech hospice and palliative care community to achieve its goals.

-Lenka Vanova

Message from NHPCO CEO and President, Edo Banach, on Sunday’s New York Times Essay

In light of an essay recently featured in the New York Times, NHPCO President and CEO, Edo Banach, issued this response:

January 9, 2018

I’m sure that many providers have seen the essay that ran in The New York Times Sunday Review this past weekend, “This Was Not the Good Death We Were Promised.”  Journalist Karen Brown shared her family’s personal experience with hospice surrounding her father’s death.  For those who have not seen the opinion piece, the experience did not end well. Ms. Brown did acknowledge the good care that was provided while her father was stable; however, when her father’s condition suddenly took a turn for the worse and he was in great pain and actively dying, the hospice failed to provide the service that was promised and expected.

This is a situation where excuses will not change this family’s experience.  And I know that no provider would find the situation she described as acceptable.

As noted in the article, I spoke with Ms. Brown.  I let her know that the situation she described was not acceptable and I would not make excuses for it.  I also explained that her experience is not that of most patients and families.

Hospice has come a long way in the 35 years since the creation of the Medicare hospice benefit.  More people are accessing care, hospices are serving a wider range of patients with diagnoses beyond cancer, and there is a greater number of providers from which people can get care.  Yet, Ms. Brown’s story reminds us that we can never stop in our efforts to provide the highest quality care possible at all times.

There will always be experiences that do not go as planned, despite the best intention. We must make sure that we learn from situations that are below our standards and we necessary adjustments to ensure preventable problems don’t happen again. As an example from this experience, providers should ensure that on-call processes are well established and that necessary back-up plans are in place. No family should fail to get a timely returned call from a hospice and a prompt visit when indicated, especially during a crisis situation.

I was moved by the number of hospice professionals that posted responses to this essay on the NY Times website. They acknowledged this situation was a failure. Many readers also shared individual reflections on personal hospice experiences that were very positive; this high level of care is something that I have seen provided by so many of you all across the country.

As a provider community, we must be sure that we take this family’s experience and use it as a learning opportunity.  We must be careful that we don’t use this “hospice failure” to disparage other provider types. Ms. Brown made a specific choice not to share the name of the hospice.  So let us take this situation as an opportunity for all of us to remember our commitment to quality and excellence.



Edo Banach, JD

President and CEO



Policy Alert: Congress Considering Changes to Hospital Discharge to Hospice

Congress is currently in the process of negotiating a package of Medicare-related legislation that would cut payments to hospitals when a hospice transfer is made sooner than a Medicare-established average length of stay.  The rationale for this change is that the federal government should not pay two providers (both hospitals and hospice agencies) for the same days of care.  A similar restriction is currently in place for when a patient is discharged to home health, psychiatric hospitals, and other settings, so this change would put hospice in the same category as other post-acute care providers.  Further, the change would save the government a significant amount of money – between $600 million and $1 billion.

NHPCO has been closely engaged on this issue since early December.  We consulted with the Public Policy Committee to discuss the potential impact of this change, and many expressed concern that this could incentivize hospitals to delay hospice referral until after the patients has stayed long enough to receive the full payment, potentially resulting in shorter lengths of stay in hospice.  NHPCO has conveyed these concerns to key legislative staff to determine whether Congress would consider alternative approaches that would assure patient access to hospice.  These conversations are ongoing, and we hope that the final policy will address our concerns and remove any unnecessary barriers to hospice.  We are also working to include the Rural Access to Hospice Act as part of the larger legislation.

All NHPCO members are encouraged to contact their members of Congress to share their concern about the proposed hospital DRG change, and to encourage them to protect hospice and include the Rural Access to Hospice Act in the Medicare extenders package.  To contact Congress about this issue, visit the Our Rural Action Center.

If you have any questions or need additional information, contact info@nhpcohan.org.

Medicare Extenders Update

Written by Sharon Pearce, VP Public Policy:

Congressional Republicans seem to have gotten their holiday wishes, as the House and Senate passed major tax reform legislation this week.  It’s been decades since Congress last made major changes to the tax code, and this has been a long-time legislative goal for President Trump and the Republican Congress.

Because tax reform consumed so much Congressional energy in the last month, Congress left several important items unfinished as it left town for the holidays. Before they adjourned, Congress passed a one-month extension to give itself more time to complete several legislative priorities, including the FY 2018 budget, re-authorization of the Children’s Health Insurance Plan, and a bill popularly known as “Medicare Extenders”.

NHPCO has been working to convince Congress to pass the Rural Access to Hospice Act as part of the Medicare Extenders package. This legislation would increase access to hospice care, especially in under-served communities by allowing clinicians at Rural Health Centers and Federally Qualified Health Centers to serve as the hospice attending physician.  All HAN Advocates are encouraged to reach out to their Members of Congress to urge them to contact committee staff to encourage them to include the Rural Access to Hospice Act in the Extenders package. Click Here to Take Action.

So that’s it for 2017.  We will need you rested and refreshed to start advocating right away in 2018!  With your help, 2018 could be a great year for hospice and palliative care policy.  Thank you for all you do to support the Hospice Action Network!