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Instructions: Use works that have been assigned to the class to support your answers or you will not receive credit. Write in complete sentences; Do NOT simply listing bullets Use proper APA citation and referencing. Points Points Lost Based on,“Exploring Hospice Care: The Who, What, Where, Why and How of End-of-Life care,” answer the following questions Explain services provided under the hospice benefit List eligibility criteria for hospice services Describe how hospice is structured to meet the needs of the terminally ill patients and their families. 25 Based on material found in assigned readings from any previous Modules only , show your understanding of the following terms: Hospice in the Care Continuum Hospice Interdisciplinary Team Hospice Plan of Care The Four Levels of Hospice Care 20 Based on, “Hospice Care Inventory Management: 5 Top Challenges” only, answer the following question: Define and discuss what are the keys to controlling costs presented in the article. 10 Based on , “Hospices Face Challenges, Opportunities in Expansion of Palliative Care,” answer the following question: What change is the article referring to regarding expansion of palliative care by hospices? What are the challenges some hospices may face in this change? (Be specific) what other problems with the hospice benefit that the article refers to? What do the authors mean when they state, “Hospices Must Evolve to Survive”? 15 Based only on , “Hospice Providers: Staffing is Our Top 2020 Challenge,” answer the following question: What is the problem that the article is referring to? What are some of the statistics and documentation the authors use to support their position? What are the causes of the problem? What are some of the solutions? 15 Read the case study below, “Eligibility and the Plan of Care” and answer the following question: What specific factors will determine if Mr. Walsh is eligible for hospice care? The hospice physician determined that Mr. Walsh is eligible for hospice services. The hospice interdisciplinary hospice team completed a comprehensive assessment, and Mr. Walsh’s plan of care (POC) was developed. What considerations does the team need to address in the POC? 15 CASE STUDY: ELIGIBILITY AND THE PLAN OF CARE Mr. Walsh is a 72-year old male who has the diagnosis of congestive heart failure, coronary artery disease, and ischemic cardiomyopathy. He is cared for at home by his wife, who is 70 years old and in fairly good health. Mr. Walsh had five hospitalizations for symptom exacerbations in the past year, which has caused loss of independence in activities of daily living, episodes of syncope, decreased appetite and ambulation, increased shortness of breath, and generalized weakness and debilitation. He has gained 15–20 pounds in the past 2 months, which has limited his activity to going from the bed to the chair or the commode chair. Mr. Walsh is prescribed 2 liters of oxygen. He has shortness of breath, intermittent chest pain (5 out of 10 on a 0–10 pain measurement scale) upon moderate exertion that is relieved with rest and nitroglycerin, 2+ pitting edema in bilateral lower extremities, a cardiac ejection fraction score of 35%, and a Palliative Performance Scale (PPS) score of 30. Mr. Walsh is not medically eligible for any aggressive treatments or surgery, and his physician has been managing his symptoms through drug therapy. Mrs. Walsh has taken excellent care of her husband, but they both believe they need additional help because Mr. Walsh’s condition is deteriorating. Both Mr. and Mrs. Walsh want to keep him at home, comfortable, with the best quality of life possible, and to avoid further hospitalizations in the future. They are people of faith and receive support from their local church in the form of parish visitors, visits from their minister, and occasional potluck deliveries. Mr. Walsh appears downhearted and with-drawn and has verbalized his fear about dying and leaving his wife alone.
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Hospice Care Inventory Management: 5 Top Challenges Posted: 4/11/17 8:00 AM    Author: Concordance Healthcare Solutions    Hospice providers deliver crucial services and care for patients and their families during the last stages of life and typically offer some form of home-based care where ever that home may be, such as: the patient’s residence a skilled nursing facility a rehabilitation center long term care facility Because hospice providers operate on very limited budgets, they need to exercise prudent control over expenses. Key to controlling costs is exercising careful inventory management. Here are five top hospice care inventory management challenges. 1. Developing Protocols and Treatment Programs Because of reimbursement challenges, great attention needs to be taken when developing care plans for patients. It’s essential that hospice providers work with healthcare suppliers to establish appropriate products for best patient care outcomes while practicing the customized treatment protocols. Staff training is an important aspect, and the healthcare disposable supplier should be able to offer assistance in this regard. 2. Cost Containment A crucial aspect of cost containment for hospice care is establishing the cost of each patient per day. One way to do this is to determine the actual cost per patient per day and to use a tracking program to monitor expenditures. It’s a good idea to work with your medical disposable supplier to work out ways to meet the budgeted patient per day cost while continuing to meet your patients’ requirements of care. 3. Mobile Ordering Needs Patient requirements are not always predictable. There’s a need to order additional supplies with minimal inconvenience. For fast and efficient service, ordering systems should be online and delivery systems should be such that timely delivery services are available. Additionally, it should be possible for supplies to be delivered direct to the patient’s home. A mobile-based ordering system means that orders can be placed immediately with supplies and costs tracked to each individual patient. 4. Inventory Control Systems The challenge of managing hospice care inventory can be eased through the use of inventory management tools linked to a database that tracks orders, deliveries and usage. Reporting tools should provide total usage figures, including items that are delivered direct to patient’s homes. The system should manage maximum and minimum stock levels and trigger order notifications when reorder points are reached. 5. Accessing Utilization Reports Hospice providers should have the ability to access utilization reports online. These should be customized to the needs of the hospice and available when required. Regular weekly and monthly reports should be automatically prepared. The administrator must be able to track costs per patient day, inventory costs, inventory usage and monitor overall spending by product and product category. By being compliant, you can take the sting out of unexpected variances. The Solution Concordance Healthcare Solutions, formed by the merger of Kreisers, MMS and Seneca, offers flexible, personalized, patient-friendly service as well as a suite of software products that simplify inventory management and patient care. These include our: Cost Per Patient Day tracking program Front Step patient supply delivery program Mobile ordering program Inventory and asset management, reporting and educational programs BeCompliant budgeting and tracking program
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NHPCO Responds to New OIG Reports on Hospice Care For Immediate Release:July 9, 2019 NHPCO welcomes the opportunity to shed a light on high quality providers as well as those that fall short in providing appropriate care. NHPCO will continue to partner with government agencies to strengthen and make more transparent the tools and data needed to empower consumers when they are choosing a quality hospice program. NHPCO will also continue to provide tools and resources to help our members to meet and exceed quality benchmarks. (Alexandria, Va) – This morning, the Office of the Inspector General released two new reports following its investigation into hospice care in the U.S.  To briefly summarize, the OIG found that 20 percent of hospices have deficiencies that put patients at risk and the OIG is suggesting that among its recommendations that deficiency data be shared more broadly to help improve quality of care. The NHPCO health policy team is reviewing the recommendations in the OIG reports and will issue a Regulatory Alert to the membership later today. News stories prompted by the OIG reports have been carried by The Washington Post, NBC News, and NPR. The journalists writing some of these news stories have shared selected patient stories based on their own investigation. These patient stories are difficult to read and reflect badly on hospice.  It is likely that other media outlets will carry these articles or generate additional news coverage on this topic. Many of the issues brought up in the new reports have been discussed in previous OIG documents going back to 2005. NHPCO has addressed these issues in the past through resources that include: Regulatory tools and alerts, quality resources, NHPCO’s Compliance Certificate Program, our updated Standards of Practice for Hospice Programs, throughout our webinar offerings, at our conferences, in our podcast series, in staff presentations to the field, and in work done by our board committees. NHPCO President and CEO Edo Banach would like to share some specific points with the field. NHPCO has been and continues to be a champion for accountability and transparency within the hospice community and we have long supported additional oversight of the hospice program, including survey frequency now at every 36 months, appropriate data collection, compliance and quality resources, and availability of education and professional development offerings to the field. Any hospice provider who fails to be fully compliant with all regulations and standards of practice and is unable or unwilling to provide the highest level of quality care should not be in the business of caring for the dying and their loved ones. The bottom line is that all hospices must ensure that every single patient receives care within all regulatory and statutory limits, that quality is never a question, and patient and family safety is never compromised. Hospices in the U.S. care for nearly 1.5 million Medicare beneficiaries and their family caregivers every year (see NHPCO Facts and Figures Report). The OIG has released information that should serve to assist the Centers for Medicare and Medicaid Services in its efforts to provide appropriate oversight of the hospice provider community and NHPCO looks forward to working collaboratively on such efforts. Extreme patient stories highlighted by the media that are not representative of the care most Americans receive can do more to frighten the public than inform them about the benefits of hospice care. NHPCO continues to stress that outliers in the field do not adequately reflect the vast majority of hospice care provision in the U.S. NHPCO believes that incidents of deliberate fraud and abuse in the hospice field, though isolated, are indefensible. However, it is necessary to understand that rare incidents of deliberate fraud and abuse should be viewed separately from unintentional documentation or mathematical errors in an extraordinarily burdensome and complicated regulatory environment. NHPCO looks forward to working with the Administration and Congress to simplify and streamline the hospice benefit and compliance process and to ease governmental red tape in order to encourage honest and law-abiding hospice providers while protecting the public from unacceptable intentional abuse. This includes better use of hospice data that CMS already obtains, educating CMS auditors, and to focus government efforts on abhorrent providers and spare compliant programs from needless and duplicative investigation. As with previous reports from the Office of the Inspector General, NHPCO recognizes the value of some of the OIG recommendations and we welcome measures that will help hospices deliver patient- and family-centered care that meets the highest quality standards. In media interviews, the OIG has clearly stated that they do not want to scare hospice patients and families away from hospice. Their focus is on quality of care and safety of patients and family caregivers, we share that with the OIG. Finally, it should be understood that hospices have a sacred obligation to serve patients and family caregivers throughout the end of life journey. As the hospice care community – like the rest of America’s health care system – continues to evolve to meet patient and family needs, it is critical that government regulations also adapt and modernize to meet the needs of those served by this unique care model.
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Hospice Industry Seeks Solutions to Issues in OIG Reports Debate continues about how the hospice industry, as well as regulators, should respond to the reports on hospice care issued in July by the U.S. Department of Health and Human Services Office of the Inspector General (OIG) that included recommendations to the U.S. Centers for Medicare & Medicaid Services (CMS) on changing their processes for evaluating compliance. The first OIG report indicated that about 20% of hospices surveyed by regulators or accreditors between 2012 and 2016 had a condition-level deficiency that posed a serious safety risk. A second report discussed 12 examples of those deficiencies in-depth. OIG examined state agency and accreditor survey findings as well as complaint data from 2012 through 2016. Regulators and accreditors surveyed nearly all hospice providers in the nation during those years. “These cases reveal vulnerabilities in CMS’s efforts to prevent and address harm that have implications for the wider hospice population,” OIG reported. “These vulnerabilities include insufficient reporting requirements for hospices, limited reporting requirements for surveyors, and barriers that beneficiaries and caregivers face in making complaints. Also, these hospices did not face serious consequences for the harm described in this report.” Though the OIG reports did identify some egregious examples of safety violations in hospices, the severity of regulatory deficiencies in general varies widely, ranging from instances that pose an immediate threat to a patient’s life and safety to relatively low-risk considerations such as clerical errors in patient documentation or a hand hygiene dispenser protruding an extra inch into the hallway of an inpatient facility. “Like a lot of things in life, it’s important to understand the context beneath [the reports]. There are some observations inside of it that will allow the industry and trade associations to begin a dialogue,” Nick Westfall, CEO of VITAS Healthcare, a subsidiary of Chemed Corp. (NYSE: CHE), said at the Home Health Care News Summit conference in September. “We can all agree that quality and transparency is absolutely a positive thing, but understanding the mechanics of it is an important component. The biggest fear is that when you start producing some of those reports without context for it, it may dissuade the exact thing that the country is trying to do and that ironically the government is trying to do, which is figure out how we get more people in to hospice and into hospice earlier.”   When it comes to concerns about hospice billing practices, the waters become even more murky. Documentation errors and omissions, live discharges and lengths of stay beyond six months are three red flags that could cause regulators to come knocking at a hospice’s door. However, though instances of fraud do exist, issues related to length of stay or live discharges often result from the ways the hospice patient population has changed since the Medicare Hospice Benefit was established in 1983.  The benefit, with its requirement of a six-month terminal prognosis, was originally designed to serve cancer patients, who have a more predictable disease trajectory than the patients with dementia and cardiac conditions that hospices care for today. Patients with these conditions are the most likely to see lengths of stay that exceed six months. “Scrutiny over lengths of stay are a product of the six-month requirement. Whether care is related or unrelated [to a patient’s terminal prognosis] or whether care is too long or too short is a product of the fact that hospice is a six-month prognosis benefit, and that patients can’t get concurrent care,” Edo Banach, president and CEO of the National Hospice & Palliative Care Organization said. “I think that should be changed, which would free providers and those who oversee them to actually look at the quality of care being provided. They are looking at the wrong thing.” The National Association for Home Care & Hospice (NAHC) recently made recommendations to CMS and other stakeholders to address the issues described in the OIG reports, including requiring CMS to publish a list of top deficiencies annually with a plan of action for addressing them. NAHC recommended increasing the frequency of surveys for hospices that have a history of serious deficiencies, including unannounced spot checks, making state agency and accreditation organization reports publicly available, and additional action to improve CMS’ process for capturing and responding to patient complaints and to strengthen the effectiveness of the survey process. The organization called for CMS to evaluate the consistency of state agency surveyor and accreditation organization surveyor actions that pertain to Medicare Conditions of Participation, as well as CMS regional office interpretations and applications. They also advocated or annual audits to ensue survey accuracy. “The OIG’s findings have made a valuable contribution to the knowledge base surrounding hospice quality of care. These include insights into the need for better education regarding commonly cited areas of deficiency as well as improved focus and appropriate corrective action toward providers that perform poorly as evidenced by a history of serious deficiencies and/or substantiated complaints,” NAHC indicated in a statement. “The OIG reports have also fostered discussion within the hospice industry around the need to eliminate inconsistencies in the survey process and flawed policy interpretations that create confusion.”
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Hospice Quality Reporting Program What is the HQRP? The Hospice Quality Reporting Program (HQRP) was established under section 1814(i)(5) of the Social Security Act. The HQRP includes data submitted by hospices through the Hospice Item Set (HIS) data collection tool, data from Medicare hospice claims, and an experience of care survey, the Hospice Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Survey. All Medicare-certified hospice providers must comply with these reporting requirements. The HQRP is currently “pay-for-reporting,” meaning it is the timely submission and acceptance of complete data that determines compliance with HQRP requirements. Performance level is not a consideration when determining market basket updates (referred to as Annual Payment Updates (APU)). Reporting compliance is determined by successfully fulfilling both the individual requirements of HIS and CAHPS®, and the submission of administrative data (Medicare claims). Penalties for Failure to Report Since 2014, failure for hospices to comply with quality data reporting requirements results in a percentage-point reduction to the Annual Payment Updates (APU). Effective with the 2022 Final Rule, beginning in 2024 penalty is increased from 2% to 4% for hospices who do not comply with the HQRP. Public Availability of Reported Data Care Compare on Medicare.gov is the official CMS website for publicly reporting quality measures for care provided by hospice and other health care providers. This site, which replaced the original Hospice Compare in 2020, was created to help consumers compare hospice providers’ performance and assist consumers in making decisions that are right for them. Consumers can search and download the publicly reported data displayed on Care Compare in the Provider Data Catalog on CMS.gov.
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End-of-Life Patient Satisfaction Hinges on Longer Hospice Care Patients receiving hospice care for a longer period of time are more likely to have high end-of-life patient satisfaction, research suggests. Share on Twitter By Sara Heath January 05, 2017 – Hospice care plays an important role in improving patient satisfaction and fulfilling end of life wishes for patients with cancer, according to a recent study published in the Journal of Clinical Oncology, but the benefits are dependent upon the duration of the service. According to the research team, hospice care offers a solution to an array of problems cancer patients face. “Patients with advanced cancer often experience pain, dyspnea, and distress at the end of life (EOL), and use intensive, hospital-based services near death,” the researchers said. “Hospice offers an alternative, patient-centered model of care focused on relieving suffering, and often delivers services within the home environment.” However, according to the researchers, positive effects of hospice care can depend upon a few external factors, most prominently length of stay.  Strategies for Integrating EHR Use into Patient Engagement  Can Online Articles Improve Patient Education, Engagement?  ACA Spurs Progress in Racial Health Disparities, But Gains Plateau To better understand the benefits of hospice care on colorectal and lung cancer patients, the research team looked at interviews with families of patients who died in 2011. These interviews, a part of the Cancer Care Outcomes Research and Surveillance (CanCORS) Consortium, included questions about the patient’s quality of life, pain management, and fulfillment of end-of-life wishes. The researchers examined a cohort of 1,970 patients, half of whom were a control group receiving no hospice care. The other half did receive hospice care. The researchers found that patients receiving hospice care tended to experience better end-of-life treatment than those who did not. Ninety-one percent were administered medication to manage pain symptoms, compared to 81 percent of control patients who reported the same. Importantly, families of patients receiving hospice care reported that their pain management regimens were appropriately tailored for their symptom levels, a key component of quality care and patient satisfaction. “Although patients enrolled in hospice have more symptoms, their symptoms are better controlled overall,” the researchers explained. “Of note, the families of patients enrolled in hospice were not more likely to report that patients received ‘too much’ pain medicine; rather, they were more likely to report that patients received ‘just the right amount.’” Specifically, 80 percent of families said their loved ones received “just the right amount” of pain medication. This compares to 73 percent of control patients. Eighty percent of families also reported that hospice patients were more likely to have their end-of-life wishes fulfilled. Seventy-four percent of control patients reported the same. The researchers also found that the positive effects of hospice care increased alongside duration of stay. For example, families of patients who spent a shorter time in hospice care (defined as less than or equal to three days) were less likely to report that patients died in their preferred place. The researchers noted that the relationship between hospice care effectiveness and duration was not linear. The difference between patients receiving little (less than three days) and moderate (between three and eight days) hospice care was negligible. The starkest difference emerged when patients entered hospice care 30 or more days prior to death. These findings suggest that providers should prioritize early enrollment in hospice care when possible. Although this may not be realistic for all patients, the researchers say clinicians should make efforts to increase the median length of stay for hospice care from the current 17.4 days. To that end, the researchers suggest amending hospice clinical quality measures (CQMs). Currently, the American Society of Clinical Oncology uses “administering hospice care” as a cancer treatment clinical quality measure. The CQM currently focuses on administering hospice care for three to seven days; however, the researchers say industry leaders should focus on enrolling patients in hospice care earlier in end-of-life care. Additionally, more research should be conducted to understand how to better deliver hospice care that fulfills all patient needs, regardless of duration of stay. “Future studies should examine whether multifaceted approaches might result in the provision of more preference-sensitive, high-quality, and value-based EOL care for patients with cancer,” the researchers concluded. Dig Deeper: Patient Satisfaction and HCAHPS: What It Means for Providers ​Palliative Care Helps Patient Satisfaction During Major Illness
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HISTORY OF HOSPICE The word “hospice” derives from the Latin word hospes, which means both “guest” and “host.” Since the 11th century, the concept of hospice was adopted by the Roman Catholic tradition to refer to a place of hospitality for the sick and dying as well as for travelers and pilgrims. The first of such hospices are believed to have been established during the Crusades. Hospices were widespread in the Middle Ages but diminished as religious orders became dispersed. The modern usage of hospice as a place for and philosophy of end-of-life care began with the work of a British physician named Dame Cicely Saunders. Dr. Saunders began work with terminally ill patients in the London area in 1948 as a nurse and earned her medical degree in 1957. In 1963, during a talk at Yale University in the US, Dr. Saunders introduced the idea of specialized care for the dying, which centered on palliative care rather than treatments to cure. In the audience were doctors, nurses, chaplains, and medical students. During this talk, Dr. Saunders showed pictures of patients who were terminally ill with cancer prior to and after receiving specialized hospice care. The difference in the patients’ appearance and overall wellbeing was remarkable, and this began the discussion in the US of providing hospice care to patients at the end of life. In 1967, Dr. Saunders founded St. Christopher’s Hospice in London, the first hospice for terminally ill patients in the United Kingdom. Dr. Florence Wald, Dean of the Yale School of Nursing, took a sabbatical in 1968 to work at St. Christopher’s to experience hospice first hand. In 1969, Dr. Elisabeth Kubler-Ross published her groundbreaking book, On Death and Dying, which contains more than 500 interviews with dying patients. In this book, Dr. Kubler-Ross emphasizes the benefits of home care over treatment in an institutional setting for terminally ill patients, and argues that everyone deserves the right to decide about their end-of-life care. In 1972, Kubler-Ross testified before the US Senate Special Committee on Aging about the right to die with dignity, a big part of which is the right to make decisions about one’s end-of-life care and to die at home. In 1974, Florence Wald, two pediatricians, and a chaplain founded the first hospice in the US—Connecticut Hospice in Branford, CT. That same year, Senators Frank Church and Frank E. Moss introduced legislation to provide federal funds for hospice programs. The legislation didn’t pass. It wasn’t until 1982 that Congress included a provision to create a Medicare hospice benefit as part of the Tax Equity and Fiscal Responsibility Act of 1982, but it contained a sundown provision for 1986. In 1986, the Medicare Hospice Benefit was enacted, and states were given the option to include hospice in their Medicaid programs. Hospice care was made available to terminally ill nursing home residents as well. For the next three decades, legislation was passed, funding was improved, and Medicare reimbursement rates were increased, resulting in the proliferation of hospice care providers. HOSPICE TIMELINE 1963 Dame Cicely Saunders introduces the idea of specialized care for the dying to the United States in a lecture at Yale University. 1965 Florence Wald, Dean of the Yale School of Nursing, invites Dame Cicely Saunders to become a visiting faculty member. 1967 Dame Cicely Saunders creates St. Christopher’s Hospice in the United Kingdom. 1968 Florence Wald takes a sabbatical from Yale to work at St. Christopher’s Hospice. 1969 On Death and Dying, written by Dr. Elisabeth Kubler-Ross, identifies the five stages through which many terminally ill patients progress. 1972 Elisabeth Kubler-Ross testifies at the first national hearings on the subject of death with dignity, conducted by the U.S. Senate Special Committee on Aging. 1974 Florence Wald, along with two pediatricians and a chaplain, founds Connecticut Hospice in Branford, Connecticut. The first hospice legislation is introduced by Senators Frank Church and Frank E. Moss to provide federal funds for hospice programs.  The legislation is not enacted. 1975 The first National Symposium on Hospice Care is convened in New Haven, Connecticut. 1977 The second National Symposium on Hospice Care is convened in Boonton, New Jersey. The third Symposium on Hospice Care is convened in Marin County, California. 1978 National Hospice Organization (NHO) is established to promote the concept of hospice care. The first national NHO conference with 1000 participants is held in Washington, DC in October. A U.S. Department of Health, Education, and Welfare task force reports that “the hospice movement …… is a viable concept and one which holds out a means of providing more humane care for Americans dying of terminal illness while possibly reducing costs.  As such, it is the proper subject of federal support.” 1979 The Health Care Financing Administration (HCFA) initiates demonstration programs at 26 hospices in 16 states to assess the cost effectiveness of hospice care and to help determine what a hospice is and what it should provide. NHO issues the first “Standards of a Hospice Program of Care,” adopted by the NHO Board of Directors in February. Cicely Saunders is made a Dame of the British Empire. First hospice program established in Africa: Island Hospice, Harare, Zimbabwe. Hospice is promoted through the film “Hospice: An Alternative Way of Care for the Dying.” 1980 Josefina Magno, MD, serves as the first full-time Executive Director/President of NHO. (1980 – 1982) The W.K. Kellogg Foundation awards a grant to the Joint Commission on Accreditation of Hospitals (JCAHO) to investigate the status of hospice and to develop standards for accreditation. 1981 Logo is officially registered as the property of the National Hospice Organization. The National Hospice Education Project is set up for the sole purpose of passing Medicare hospice legislation. First AIDS case is defined. 1982 Congress includes a provision to create a Medicare hospice benefit. Carl Akins serves as Executive Director/President of NHO. (1982 – 1983) Addition of hospice benefits in many third-party payer insurance plans.  (1982 – 1985) Proclamation of the first National Hospice Week in November. NHO’s fifth annual meeting is held in Washington, DC. NHO grows to twelve full-time paid staff. NHO joins the Medicare Initiative. NHO’s first television PSA is aired, featuring actor Jack Klugman. 1983 Initial Medicare Hospice Regulations are published in the Federal Register.  Regulations establish the four levels of care and outline the cost components of the routine home care rate. JCAHO initiates hospice accreditation. Human Immunodeficiency Virus (HIV) is isolated. Louise Bracknell serves as Executive Director/President of NHO. (1983 – 1984) 1984 John J. Mahoney serves as Executive Director/President of NHO. (1984 – 1998) Dr. William Lamers is recognized with the NHO Founder’s Award. The Joint Commission Hospice Accreditation Program is implemented. The human immunodeficiency virus (HIV) is recognized as the cause of HIV/AIDS, and research on zidovudine and other treatments gets underway. 1985 Dr. Josefina Magno, Dennis Rezendes, and Don Gaetz are recognized with the NHO Founders Award. Consolidated Omnibus Budget Reconciliation Act of 1985 (“COBRA ‘85”)  does the following: Medicare Hospice Benefit is made permanent. States are given the option of including hospice in their Medicaid programs. Permits payment of separate room and board rate for hospice patients residing in nursing facilities. 1986 Rev. Edward S. Dobihal, Jr. and Shirley Dobihal are recognized with the NHO Founder’s Award. Ann Morgan Vickery is recognized with the NHO Woman of the Year award. First NHO conference on management and interdisciplinary development is held. 1987 Florence Wald and Zach Morfogen are recognized with the NHO Founder’s Award. First Anti-retroviral drug (AZT) is approved by the US FDA to treat people with HIV but is unavailable to most people in Africa. 1988 Ewart V. Thomas is recognized with the NHO Founder’s Award. Initiation of CHAP (Community Health Accreditation Program) hospice accreditation program. The tenth anniversary of NHO is celebrated at an annual meeting in Orlando. 1989 Reverend William Manger is recognized with the NHO Founder’s Award. The Government Accounting Office releases a study stating that only about 35% of eligible hospices are Medicare-certified. Congress gives hospices their first increase (20%) in reimbursement since 1986 and ties future increases to the annual increase in the hospital market basket through a provision contained in the Omnibus Budget Reconciliation Act of 1989. 1990 Dr. Balfour Mount is recognized with the NHO Founder’s Award. Passage of the Omnibus Reconciliation Act (OBRA 1990) establishes an unlimited fourth election period for the Medicare Hospice Benefit (final rule published 6/12/91). 1991 The Commission on the Future Structure of Veterans Health Care (Mission Commission) releases a report recommending inclusion of hospice care in the veteran’s benefit package. Dr. Derek Doyle is recognized with the NHO Founder’s Award. Department of Defense authorizes coverage of hospice care in military hospitals or under CHAMPUS. Patient Self Determination Act (PSDA) becomes effective and requires all health care providers, including hospices, to discuss advance care planning wishes with patients during the admission process. 1992 Congress passes the Indian Health Care Improvement Act of 1992, calling for a hospice feasibility study. National Hospice Foundation (NHF) is established. Dame Cicely Saunders and Dr. Sylvia Anne Lack are recognized with the NHO Founder’s Award. FDA approval of Combined Therapy for HIV/AIDS. 1993 Hospice is included as a nationally guaranteed benefit under President Clinton’s health care reform proposal. Dr. Elisabeth Kubler-Ross is recognized with the NHO Founder’s Award. NHO coordinates the display of the AIDS quilt in Salt Lake City. An estimated 9 million adults in sub-Saharan Africa are infected with HIV, with 1.7 million AIDS cases. 1994 HCFA sends a memorandum alerting the regions of problems regarding questionable certifications and recertifications of terminal illnesses, resulting in the first “focused medical review” for hospices. Dr. Robert Twycross and Dr. William M. Lamers, Jr. are recognized with the NHO Founder’s Award. 1995 HCFA releases an expanded version of the Hospice Interpretive Guidelines, which provides much needed clarification of the Conditions of Participation. The Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) Hospice Benefit is implemented in June. The Office of Inspector General announces Operation Restore Trust, a special program to combat waste and abuse in Medicare and Medicaid in five targeted states—California, Florida, Illinois, New York, and Texas—later expanded to include hospice. Mary Taverna is recognized with the NHO Founders Award. 1996 Hugh Westbrook is recognized with the NHO Founders Award. Bills are introduced in the U.S. House of Representatives and the U.S. Senate to make technical changes and improvements to the Medicare Hospice Benefit. National Hospice Organization publishes Medical Guidelines for Determining Prognosis in Selected Non-Cancer Diseases. Initiation of ACHC (Accreditation Commission for Home Care) hospice accreditation program. Home Box Office and NHF create and air the documentary Letting Go:  A Hospice Journey, which gives viewers an intimate look at hospice care. Hospice: A Photographic Inquiry – Organized by the Corcoran Gallery of Art and the National Hospice Foundation, explores the collaborative experience of hospice care through the eyes of artists. The Corcoran commissions five photographers to create new works about hospice for this exhibition. The show opens in Washington, DC at the Corcoran and then travels to 18 cities across the country. 1997 Operation Restore Trust is extended and expanded to target all 50 states and additional types of health care providers. The Balanced Budget Act of 1997 (BBA 97) includes hospice provisions that restructure the hospice benefit periods and remove physician services from the employee-only requirement for the core services requirement.  BBA 97 also reinstates a hospice cost report and reduces hospice payment updates by market basket minus one percentage point. The growing end-of-life movement focuses national attention on quality of life at the end of life as well as the need for increased public awareness and physician education.    NHF conducts national research to learn more about America’s attitudes regarding end-of-life care. That Gallup survey finds that most adults would prefer care at home and would seek a hospice program if they had six months or less to live. The survey also reveals that most Americans do not realize that hospice care is available at home, and that costs are typically covered by Medicare or private health insurance. 1998 Karen Davie serves as Executive Director/President of NHO. (1998 – 2001) Hospices nationwide report rapidly declining average and median lengths of stay. The percentage of hospice non-cancer admissions decreases dramatically, reflecting the problems associated with determining a six-month prognosis for these patients. NHO’s Medical Guidelines for Determining Prognosis in Selected Non-Cancer Diseases becomes policy through the development of Local Medical Review Policies by Fiscal Intermediaries. An Operation Restore Trust report on hospice states, “Overall, the Medicare hospice program seems to be working as intended.” Care Beyond Cure: Physician Education in End-of-Life Care is released by the Annenberg Center for Health Sciences and the National Hospice Foundation. The U.S. Postal Service issues the Hospice Care commemorative stamp in February. 1999 The Health Care Financing Administration (HCFA) releases the Hospice Cost Report. Medicare-certified hospice programs must file cost data for each fiscal year on or after April 1, 1999. The Office of Inspector General releases the Draft Compliance Program Guidelines for the Hospice Industry. The National Data Set Survey is initiated by NHO with the goal of creating standardized data collection nationwide. Foundation for Hospices in Sub-Saharan Africa (FHSSA) is founded in New York State, with Bernice Catherine Harper as President, to mobilize a response to the sub-Saharan HIV/AIDS pandemic and support Africa’s hospice and palliative care programs’ ability to provide compassionate care. AIDS becomes the number one cause of death in sub-Saharan Africa. 2000 The National Hospice Foundation launches a public service campaign of TV ads across the U.S.; one of these ads wins the prestigious ADDY Award. U.S. Senate holds two major hearings on end-of-life care and discusses barriers to access under the Medicare hospice benefit. National hospice community calls for more consistent Medicare surveys. The Duke Institute on Care at the End of Life is established. PBS series On Our Own Terms: Moyers on Dying in America is the focus of national education and engagement programs. Research from the Department of Health and Human Services demonstrates findings that support the provision of hospice care for residents of skilled nursing facilities. NHO changes its name to National Hospice and Palliative Care Organization (NHPCO). 2001 The passage of the Benefits Improvement and Protection Act of 2000 brings a five percent increase in the Medicare hospice reimbursement rates. A Call for Change: Recommendations to Improve the Care of Children Living with Life-Threatening Conditions is released by the Children’s Project on Palliative/Hospice Services. The Health Care Financing Administration (HCFA) becomes the Centers for Medicare and Medicaid Services (CMS). 2002 J. Donald Schumacher, PsyD, becomes Executive Director/President of NHPCO. Twenty-fifth anniversary of the Medicare Hospice Benefit. The Department of Veterans Affairs launches a program to increase veterans’ access to hospice and palliative services while providing educational opportunities for clinicians in veterans’ healthcare facilities. Rallying Points, an initiative of Robert Wood Johnson Foundation’s Last Acts campaign, begins a three-year initiative to improve care and caring near the end of life. Claire Tehan is recognized with the NHPCO Founder’s Award. 2003 National Hospice and Palliative Care Organization celebrates its 25th anniversary. NHPCO gives a grant of $100,000 to the Veterans Health Administration to begin the Veterans Administration Hospice and Palliative Care (VAHPC) initiative. A Clinical Guide to Supportive and Palliative Care for HIV/AIDS is released by the U.S. Health Services Resource Administration at The White House Conference on Palliative Care and the HIV/AIDS Global Pandemic. The web-based Family Evaluation of Hospice Care (FEHC) Survey is launched. The hospice awareness ribbon is unveiled prior to November’s National Hospice Month. 2004 More than 1 million Americans with a life-limiting illness are served by the nation’s hospices, the first time the million-person mark has been crossed. The Clinical Practice Guidelines for Quality Palliative Care are published in May by the National Consensus Project, a consortium of palliative care and hospice organizations. The Diana, Princess of Wales Memorial Fund and the Franklin Mint make a $3.35 million gift to NHPCO to promote better end-of-life care. 2005 Caring Connections, NHPCO’s consumer engagement initiative launches the comprehensive “It’s About How You LIVE” national campaign. Robert Wood Johnson Foundation continues its support of NHPCO’s Caring Connections consumer engagement initiative with an additional $4.9 million grant. The Department of Veterans Affairs releases the report, VA Transforms End-of-Life Care for Veterans. National dialog on the importance of advance care planning increases as the case involving Terri Schiavo—who dies in March—escalates in the media and within public policy debates. The first national conference on access to hospice and palliative care is hosted by NHPCO in St. Louis. The Society for Nonprofit Association Publishers awards NHPCO the EXCEL Gold Award for its hospice education print advertising series. The number of hospice provider organizations throughout the country tops 4,000 for the first time. J. Donald Schumacher testifies at a Hearing on “Health Care Provided to Non-ambulatory Persons” to the Committee on Health, Education, Labor and Pensions, United States Senate. 2006 A celebration of Dame Cecily Saunders’ life is held in Westminster Abbey on March 8; the U.S. hospice community issues a resolution honoring her. A Guide to Supportive and Palliative Care for HIV/AIDS in Sub-Saharan Africa is released; the publication is funded by the U.S. Government through the HIV/AIDS Bureau, Health Resources and Services Administration, and NHPCO. Quality Partners, developed to build organizational excellence and improve hospice and palliative care delivery and outcomes, is launched by NHPCO. Inaugural World Day is held on October 1 to focus global attention on hospice and palliative care with events in 70 countries. A National Framework and Preferred Practices for Quality Palliative and Hospice Care is published by the National Quality Forum. The African Palliative Care Association (APCA) is established in Kampala, Uganda, and provided funding by NHPCO. PEPFAR/USAID awards FHSSA a New Partners Initiative grant totaling $5,008,849. 2007 Research published in the Journal of Pain and Symptom Management reports that hospice patients live an average of 29 days longer than similar patients who did not have hospice care. Findings of a major study out of Duke University published in the Journal of Pain and Symptom Management show that hospice services save money for Medicare and bring quality care to patients and families. The National Quality Forum releases A National Framework for Palliative and Hospice Care Quality Measurement and Reporting. The Alliance for Care at the End of Life (ACEOL), a 501(c)4 organization, is created to provide the hospice community with a comprehensive, strategic voice on Capitol Hill. The Worldwide Palliative Care Alliance is formed to address global care needs at the end-of-life.  NHPCO becomes a member. 2008 The inaugural National Healthcare Decisions Day is held on April 16. NHPCO and its affiliate organizations (National Hospice Foundation, FHSSA, and The Alliance for Care at the End of Life) move into the National Center for Care at the End of Life in Alexandria, Virginia. The first major revision of Medicare Hospice Conditions of Participation (CoPs) since the Medicare Hospice Benefit was established is published as a final rule in the June 5, 2008 Federal Register. Results of first Quality Improvement Organization (QIO) hospice initiative, the PEACE Project, provide quality measures and develop an instrument to measure quality of care at the end of life. 2009 The Accreditation Council for Graduate Medical Education, a private, non-profit organization responsible for the accreditation of post-MD medical training programs within the United States, adds hospice and palliative medicine to its list of accredited programs. The number of hospice volunteers continues to grow with a record 550,000 serving as volunteers. The NHPCO Standards of Practice for Pediatric Palliative Care and Hospice, along with the companion publication Facts and Figures on Pediatric Palliative and Hospice Care in America, are released. Hospice leaders from the U.S. meet HRM Queen Elizabeth II at the Silver Jubilee Celebration for the U.K.-based Help the Hospices. Research published in the Archives of Internal Medicine suggests benefits of advance care planning discussions with physicians include lower costs and reduced utilization of aggressive care at the end of life. Quality Guidelines for Hospice and End-of-Life Care in Correctional Settings is published by NHPCO. FHSSA celebrates its 10 Year Anniversary with fundraiser in Denver as part of NHPCO’s Clinical Team Conference. 2010 NHPCO Standards of Practice for Pediatric Palliative Care and Hospice receive American Academy of Pediatrics Affirmation of Value. We Honor Veterans, a pioneering campaign to help improve the care Veterans receive from hospice and palliative care providers, is launched by NHPCO in collaboration with the Department of Veterans Affairs. The Patient Protection and Affordable Care Act is passed by the Congress.  A provision requires state Medicaid programs to allow children with a life-limiting illness to receive both hospice care and curative treatment. Alliance for Care at the End of Life changes its name to Hospice Action Network (HAN). 2011 NHPCO publishes the report, Private Conversations and Public Discourse: The Importance of Consumer Engagement in End-of-Life Care. The Concurrent Care for Children: Implementation Toolkit is released by NHPCO and the District of Columbia Pediatric Palliative Care Collaboration. Campaign for the National Center for Care at the End of Life is launched by National Hospice Foundation. Ethical Marketing Practices position statement and commentary are released by NHPCO. The bicameral Wyden-Roberts HELP Hospice Act is introduced in Congress. Association Trends awards NHPCO the 2011 All Media Contest Gold Award for the 26th Annual Management and Leadership Conference Learning Journal. 2012 LIVE—Without Pain, a new public awareness campaign from NHPCO’s Caring Connections, is launched to dispel myths about pain and empower consumers. An innovative, online advocacy resource, the Legislative Action Center, is created online by the Hospice Action Network. More than 1.5 million people are reached through the six-part online video series, Basics of Hospice. Ann Morgan Vickery receives NHPCO’s “Healthcare Architect Award”. Bernice Catherine Harper receives the Global Vision Award in recognition of her work in expanding access to palliative care in Africa. The Hospice Action Network hosts its first Advocacy Intensive to educate clinical front-line caregivers about hospice policy and how to advocate for hospice on Capitol Hill and at home. 2013 Research from Mount Sinai’s Icahn School of Medicine demonstrates cost savings of hospice; NHPCO and Hospice Action Network work to take this research to legislators and the media. ehospice is launched as a globally run online news and information resource committed to offering the latest news, commentary and analysis from the world of hospice and palliative care. ehospiceUSA is powered by NHPCO. NHPCO and HAN host “Conversations Before the Crisis,” a symposium focused on Advance Care Planning. 2014 Forty years after the creation of Connecticut Hospice, NHPCO and its affiliates celebrate 40 years of hospice care in the US. Moments of Life: Made Possible by Hospice public engagement campaign is launched at the NHPCO Management and Leadership Conference. FHSSA expands its mission globally and is re-launched as Global Partners in Care. At the HAN Advocacy Intensive, participants secure signatures from 202 U.S. Representatives and 75 U.S. Senators on letters urging CMS to halt implementation of Part D guidance that negatively impacted hospice providers, patients, and families. Congress passes the Improving Medicare Post-Acute Care Transformation Act, or “IMPACT Act”, and President Obama signs it into law. 2015 We Honor Veterans initiative is awarded the prestigious Summit Award by the American Society of Association Executives. Additionally, ASAE awards Global Partners in Care with its Power of A Gold Award. Moments of Life: Made Possible by Hospice public engagement campaign is recognized with the eHealthcare Leadership Gold Award, and Bulldog Reporter’s Gold Award for Best Non-profit Campaign. 2016 CMS launches hospice payment reform – the first change to the Medicare hospice payment system since the benefit was established. Don Schumacher retires as CEO/President of NHPCO. Edo Banach, JD, is hired as CEO/President of NHPCO.   2017 For the 10th anniversary of National Healthcare Decisions Day, NHPCO & HAN hosted a Capitol Hill briefing on advance care planning. We Honor Veterans reached more than 4,500 partners since the program launch. The exhibit “Hospice: A Historical Perspective” went on permanent display at NHPCO. 2018 The Medicare Patient Access to Hospice Act was signed by the President in February. Launched the national My Hospice Campaign in April designed to reinforce the value of the Medicare hospice benefit among policy and health care decision makers. The Hospice Compliance Certificate Program was launched at the Interdisciplinary Team Conference in New Orleans in November. Legislation was passed to address the Opioid crisis that included a safe disposal provision for qualified hospice staff.
The questions are attached Im attaching all the material for the questions Submit writing assignment only in a word document as “docx” documents only; do not send PDF files. These files will not
Advantages and Disadvantages of Hospice Care By Angela Morrow, RN Updated on February 24, 2020 What are the advantages and disadvantages if you or a loved one enters hospice care?   Hospice services   are a specialized form of medical care that seeks to provide comfort and maintain a patient’s quality of life (to the greatest extent possible) for those facing a life-limiting illness, disease or terminal condition. While this care generally attempts to provide holistic comfort and dignity as death approaches, hospice might or might not be the right choice for you or a loved one depending on your unique needs and/or situation. Here are some of the possible advantages and disadvantages of hospice care that you should consider. Advantages  Hospice includes comprehensive, interdisciplinary care from a team of professionals and hospice volunteers . This care can involve physicians, case manager nurses , home health aids , certified medical social workers , chaplains and trained hospice volunteers to meet the needs of the patient and his or her family members or personal caregivers.1  Care is available 24 hours a day, including weekends and holidays . Patients and their family members or personal caregivers always have access to hospice professionals when they need assistance.  Choosing hospice usually results in a reduction in your out-of- pocket expenses for medications, durable medical equipment, and medical supplies . Medicare, Medicaid and/or your private insurance typically cover the cost of these necessary items for hospice patients.2  When a patient is truly ready for comfort care , choosing hospice care can also mean avoiding unwanted hospitalizations, medical treatments, and procedures . The goal of the entire hospice team is to support the wishes of the patient and his or her family members and personal caregivers while helping them achieve their goals for care.3 Disadvantages A potentially significant disadvantage of choosing hospice care might arise because of the restrictions placed on the various aspects of treatment. Under the Medicare hospice benefit, a hospice receives a flat per-day amount of money from which all medical expenses must be paid. This can result in several difficulties, such as:  Denial of some diagnostic tests , such as blood work and X-rays. Even if requested by the patient’s attending physician, the cost of these tests still becomes the financial responsibility of the hospice agency. Because these tests are expensive and might not always prove beneficial, hospice agencies often will not approve them.  Hospitalization is discouraged once a patient enters hospice care . While the Medicare hospice benefit does contain provisions for short-term hospital stays (called inpatient care ) for symptom management, the criteria for admission and coverage for specific treatments are poorly defined.4  Participation in experimental treatments or clinical trials is not allowed because they are considered life-prolonging. In addition, other treatments or procedures considered life-prolonging nasogastric or “feeding” tube , might not be covered.5
The questions are attached Im attaching all the material for the questions Submit writing assignment only in a word document as “docx” documents only; do not send PDF files. These files will not
https://hospicenews.com/2020/02/11/hospice-providers-staffing-is-our-top-2020-challenge/ This is for the fifth question https://www.weatherbeeresources.com/post/design-a-stunning-blog This is for the fourth question https://www.slideshare.net/VITASHealthcare/exploring-hospice-care-vitas-healthcare-90950658 This is for the first question You must include clear healthcare examples for each and every question to show that you understand the question and the answer. All answers must come from the course reading material and you must cite all reference material, using the APA method only.