And so it goes, friends.

In October of 2009, I had on an ill-fitting suit, and I was nervously traveling towards the King Street Metro station. I had a flip phone (this was before smartphones were ubiquitous), and back then if you sent a text message question to 46645, it would text you back an answer (I didn’t know at the time that 46645 was owned by google…).

The question I needed to know the answer to that day was ‘what is palliative care?’

I was on my way that day to interview for a position at NHPCO and what is now the Hospice Action Network, and I hadn’t researched exactly what palliative care was before heading to my interview (sorry, Angie…). I didn’t know how much my life would change that day as my Orange Line train sped through a sunny Arlington National Cemetery. Just over six years later, it’s time for me to say goodbye. Today is my last day at NHPCO and HAN.

Lauren has been asking me to do a closing post for over a month now, and to be honest, I’ve been putting it off. Even now, I don’t know what to say. How do you wrap up everything that the hospice community has meant to you for the last half-decade? How can you fit that into a social-media-optimized blog post? Even if I was given months to write it all out, I don’t know what I’d say.

If I had to boil it all down, I guess I’d say this: thanks. Thanks to each and every one of you out there who touches the lives of patients and families facing an end of life experience. Thanks for dealing with other people’s grief, pain, and anguish with poise, grace, and compassion. Thanks for opening our emails and taking action when we’ve asked. Thanks for picking up the phone when we call asking for “a quick chat”. Thanks for coming to D.C. to tell your hospice stories to Congress.

Thanks for everything.

Hospice in the US is dynamic. It is currently dealing with a changing landscape and pressure from all sides. And yet, in the midst of everything, I have never met a group of people more willing to help. It’s in your nature. I know I can speak for the entire team here at NHPCO when I say that we come to work energized every single day because we get to work with and for such an amazing group of people.

One final note of thanks- to the HAN team, in whose incredibly capable hands things will continue. Sharon Pearce is a force of nature- she is an amazing tactician and is doing wonderful things for our community on Capitol Hill. Jon Keyserling gives us all room to run and has our backs no matter what. Karen Davis’s ability to analyze policy and churn out good copy is fantastic, and I have seen her come more into her own than possibly anyone else on the HAN team. Lauren Drew’s relentless energy and enthusiasm is so boundless we’ve considered drug testing her (joke). This team is seamless and limitless. The hospice community could not be in better hands, policy-wise.

Anyway, enough. I will miss you all very much, but I’m not going far. I’ll still be in the hospice community, and I look forward to crossing paths with many of you in the future.

Until then…

A View From The Hill… Six Years Ago.

Lauren asked me to contribute to the blog for the next two days, the reasons for which I’ll reveal tomorrow. I’ve recently been reflecting on my time here at NHPCO, and I remembered that I was asked to write a blog post very soon after I started. It was the height of Healthcare Reform, right before the law was actually signed. Believe it or not, because we keep everything around here, I was actually able to find it! We move on to new issues with such speed these days that I thought it might fun to look back. (I don’t want too much guff from Lauren that I’m not doing this on #throwbackthursday…)

Diving Right In: Life in the Deep End

Tony Kudner, Program Assistant II, Public Policy

It’s 8:15 on a cold Thursday morning in December and I’m getting off the metro at the Capital South Station in Washington, D.C. I’m headed to the cafeteria of the Longworth House Office Building, not 200 yards from the Capitol. On this particular morning, just my sixth day of work as a part of NHPCO’s Public Policy Team, I’ll be sitting in with the rest of the team as they brief a hospice delegation from New York State on hospice’s legislative ‘ask’ as it relates to health care reform. How did I get here? What have I gotten myself into?

Such is life in the deep end. With the health care reform effort in full swing, the Public Policy Team here at NHPCO has been working around the clock to advocate both nationally and on the local level for hospice care in our country. I have been plunged into this process, and so far I love it. The briefings I sat in on were a smaller version of the Hill Day sessions that accompany the annual Management and Leadership Conference in April. In these meetings, local delegations impress upon their elected Congressmen and Senators just how important Hospice is both to the health care reform effort and to the public at large.

The meeting was eye-opening. Director of Public Policy Angie Truesdale gave an overview of the political situation surrounding health care reform legislation. The New York State delegation discussed the unified message that they would bring to their Representatives and Senators. I was excited to observe this precursor to the legislative process. Until you’ve seen advocacy at the federal level, you might imagine it to all be done by Washington insiders— I’m here to tell you that this isn’t the case. The Hospice Advocates who came in from New York State were from local hospice providers. They didn’t fly in on private jets, and they carried their own luggage. It was interesting to see that these advocates were people much like you or I. I can’t imagine what it must be like to sit down across the table from Charles Schumer or Kirsten Gillibrand, but these people did it, and then went back home to continue work at their hospices.

From the moment I began work here at NHPCO, I have been impressed by the knowledge and focus of the Public Policy staff. As the newest member of this team, I could not be more excited to be a part of NHPCO’s public policy efforts. Before I started here at NHPCO, I worked in live event design and production. Over the last month I have discovered several key similarities between my old profession and the field of public policy. Both require resourcefulness and hard work. Deadlines always seem to loom and there are fires to be put out and problems to solve.

However, I think the biggest similarity between the two comes down to this: passion. In event design, the hours are long and the work is often difficult and exacting. Similarly, in advocacy we have to juggle competing priorities and stay on top of the ever-changing political landscape here in the Capital. The people I work with all share a passion for what they do- the workday doesn’t always end right at 5:30. It’s not uncommon for me to listen in on a conference call with Jonathan Keyserling as he explains the intricacies of MedPAC policy to the Council of States. Whenever I walk by Angie Truesdale’s office, I can hear congressional chatter on C-Span in the background. I get several emails a week from Michele Matthews containing updates about new media rollouts for the coming weeks and months. I check in on the NHPCO Youtube page to look at new content posted by Jonathan Randall. The people in this department truly have a passion for Hospice Advocacy and it shows every time I walk into our office.

I’m glad to be a part of this hard work. As the new program assistant of public policy, I’ll be helping the team with projects across the board. I look forward to sharing more about my experiences in the coming months. Until next time, I’ll see you in the deep end…

You know, a lot has changed in six years, but an awful lot has stayed the same. We still throw everyone in the deep end, and the folks who still matter the most are you guys. You had the power to change how Healthcare Reform affected hospice then, and you have that same power today.

Keep swimming in the deep end, friends, and I’ll have another post for you tomorrow.


All States Being Equal, Utah, Oregon, Virginia and Georgia are the Best

Controversial statement, eh? Let me explain with a quick civics lesson. There are 435 members of the House of Representatives, with members distributed across the states based on population. Members from California, Texas, New York and Florida make up a quarter of all House members. If they act together, those delegations can be really powerful.

In the Senate, however, each state gets two Senators, no matter what its size. Wyoming’s two Senators have just as much power and influence as New York’s.

But when it comes to hospice policy, not all Senators are created equal. Senators on the Finance Committee have more influence over health care policy than members of, say, the Judiciary committee. That’s just the way the Senate committees are structured.

Now in case you missed our multiple emails, posts and columns this past week, the Senate Finance Committee is considering a proposal to “carve-in” hospice under Medicare Advantage (private Medicare health plans). This change could significantly affect hospice by inhibiting patient access to the hospice of their choice, impacting hospice quality, and creating administrative and financial headaches for hospice staff.

To stop this from happening, we need advocates from these states to contact their Senators and urge them to OPPOSE the proposal to include hospice in MA.





If so, we need you to call your Senators!!!


We especially need help from hospices in Utah, Oregon, Virginia and Georgia — Senators from those states are the ones leading this effort.

Click here to take action.  We’ll tell you who to contact and give you a sample email to get your started, but feel free to personalize your message to explain why YOU think this would be bad for patients.  If you’re not from one of the key states, that’s OK – you can still email your Senator.  Every email helps.

If you have any questions, as always, just ask.  And if you hear anything back from your Senators, let us know.



Join Us Tonight at 9pm EST/6pm PST!

Join HAN for a live event coinciding with tonight’s State of the Union Address! Connect with Hospice and Palliative Care Advocates around the country as we chat about the State of the Union, hospice and palliative care policy, and more! You can follow along here. 

Don’t forget to use #HPMSOTU to get in on the conversation!


Don’t have Twitter? You can still watch the speech and the commentary on our website!

Do you support Hospice being included in Medicare Advantage?

A recent article by David Stevenson and Haiden Huskamp on the Health Affairs blog takes issue with the recent Hospice Payment Reform, and says it does not go far enough. The article (available here) says that three specific issues remain unaddressed:

  • The barriers to care posed by current hospice eligibility standards.
  • The exclusion of hospice from Medicare Advantage and other integrated payment models.
  • The poor fit of the current hospice benefit for nursing home residents.

Do you support Hospice being included in Medicare Advantage? The Senate Chronic Care Working Group has proposed including hospice in Medicare Advantage (see Karen’s post on this topic), and NHPCO has heard from some members of the hospice community that are opposed to this idea. We are currently developing a response to the Senate Working Group’s request for comment. We will have additional information in the coming weeks, but in the meantime, what do you think about this proposal?