In The News

How Fraudulent Hospices Evade Regulators

Hospice News | By Jim Parker

A slew of fraudulent hospices in California are dodging consequences by shuffling patients around between provider numbers.
 
That’s according to multiple sources who spoke with Hospice News, expressing their concerns about patterns of fraud continuing even as government regulators crack down on the sector.
 
Since 2021, numerous media and government reports have emerged of unethical or illegal practices among hundreds of newly licensed hospices, particularly among new companies popping up in California, Texas, Nevada and Arizona. Despite the best efforts of regulators and law enforcement, hospice leaders are concerned that many bad actors are slipping through the cracks.
 
“As more regulation comes in, it really doesn’t matter. You can give me a regulation right now and in three seconds, I can give you a way to work around it,” a hospice owner told Hospice News on condition of anonymity. “Because I know my industry, I can find a work-around for any regulation … Our systems are filled with loopholes.”
 
Industry associations also are aware of this issue, according to Logan Hoover, vice president of health policy and government relations at the National Hospice and Palliative Care Organization (NHPCO).
 
“It is deeply concerning that we continue to see sophisticated fraud attempts in multiple states, targeting beneficiaries and defrauding taxpayers. These deceitful actions reveal that serious vulnerabilities still exist in our system,” Hoover told Hospice News in an email.
 
One principal tactic among these hospices is maintaining multiple provider numbers, hospice leaders told Hospice News on background. This enables perpetrators of fraud to move patients between the various hospices they own. Another common practice is transferring patients who have reached the payment cap to avoid recoupment.
 
“I always get agencies that ask me to swap patients with them,” a hospice CEO said. “They say, ‘Maybe we can swap some patients out this way and you can eat into your cap, because my patients don’t have cap space.’”…

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It’s Okay Not to Eat! Food at End of Life

By Barbara Karnes

FOOD! We eat to live. It sustains living. Everyone and everything needs some form of food, of nourishment, to maintain life. Animals (and that includes humans), plants, insects, all need some form of food to live. It seems that with humans, we add to the nourishment aspect of eating a social component as well as an emotional one. We socialize with food. We show love with food.

My husband Jack has been dead eight months. In processing the five months from his diagnosis to his death, what stands out most for me is the tension that surrounded food. AND I KNEW BETTER!

As his body was declining, I experienced a driving intensity to feed him. He ate less and less, while I pleaded, badgered, coaxed, and pushed food on him. His not eating “enough” became our biggest point of tension. I never said, “You are dying and you need to eat,” but I was thinking it.

One day after a particularly tense session of his not eating and my strongly encouraging him to eat, I left the room in tears. It was then that I saw the obvious: I was trying to keep him alive while his body was preparing to die. Even with all my knowledge of end of life, my husband was going to die and my feeding him wasn’t going to change the outcome. It was only making this precious time together more challenging and disruptive.

I‘ve thought about my reactions. If I felt this frustration and even panic with all the knowledge and experience that I have, how do others, without the knowledge, cope? Probably poorly. SO I wrote a booklet, Always Offer, Never Force. This short booklet is in the format of my others. It addresses eating and not eating as end of life approaches, with some nutritional guidelines as well as what foods to offer. 

Just as there are new rules in pain management, in sleep, in socialization at end of life, there are new rules for eating. My hope is that by reading about the normal progression of eating to not eating and what to do to help our special person during that time, my booklet can guide and support others as they journey this challenging road toward life’s conclusion.

How do I see Always Offer, Never Force being used?

  • Always Offer, Never Force is a companion to Gone From My Sight and The Eleventh Hour.
  • Include it with the initial hand out materials.
  • Read it with families and caregivers as a teaching tool. 
  • Brand it with your agency name and logo.
  • It is not just for Hospice use, but for Palliative Care programs and End of Life Doulas, as well.
 

How Do You Train Your Hospice Volunteers?

By Barbara Karnes

I was thinking about hospice volunteer training. What makes a good training program? I am hearing stories about the lack of professional staff training for new hires, which led me to wonder about volunteer training. 

So - here are my thoughts for a hospice volunteer training program:

  1. At the first meeting of the training, have a discussion focusing on why the person wants to be a volunteer in the end of life arena. It is not an area most people are interested in, so why are they?
  2. When was their last experience with death? Often there can still be unresolved grief issues. I suggest that at least one year has passed since the death of a significant person in the potential volunteer’s life. Working with end of life patients may trigger their own memories and interfere with objectivity in giving help. (Note that steps 1 and 2 should come before the following steps. We need to see why they are drawn to this area before anything else. These steps may be the time that the prospective volunteer decides hospice volunteering is not the work for them. It is also the point at which the hospice coordinator decides it is not a good fit for the applicant.)
  3. Now explain the role of a volunteer. Go over what is expected and what is not acceptable. 
  4. Begin teaching the signs of approaching death. Go over what the signs will look like in the months, weeks, and hours before death. Particularly address how eating, sleep, socialization will change. Provide lecture-style teaching, take-home reading materials, and written assignments.
  5. Teach the basics of nutrition, skin care, pain management, and monitoring activity levels. Not because the volunteer will be doing care, but because they are the eyes of the professional staff and can report their observations.
  6. Teach effective and sensitive communication and active listening skills.
  7. Go over the specifics of dementia at end of life and how to interact with someone with the disease.
  8. The basics of grief are another important component of end of life training. Again, lecture and provide reading materials and written assignments.
  9. Offer guidance on self-care. Offer guidance on the importance of entering the patient/caregivers life as a support person, and how we don’t become personally involved. Lecture on creating a closure ritual, having a buddy system, and when and how to contact a bereavement coordinator for personal support should the need arise.
Convey the importance of attending monthly volunteer discussion groups. These groups are a coming together of active volunteers for conversation, support, and continuing education inservice.


I suggest The Final Act of LivingBy Your Side and the End of Life Guideline Series Bundle be required readingThese will provide a strong baseline in end of life knowledge. I also recommend these for medical professionals working in the end of life area.

 

New Gene Tests Can Predict if a Drug Will Work for a Patient

Medscape | By Sari Harrar

What if there were tests that could tell you whether the following drugs were a good match for your patients: Antidepressants, statins, painkillers, anticlotting medicines, chemotherapy agents, HIV treatments, organ transplant antirejection drugs, proton pump inhibitors for heartburn, and more?

That's quite a list. And that's pharmacogenetics, testing patients for genetic differences that affect how well a given drug will work for them and what kind of side effects to expect.

"About 9 out of 10 people will have a genetic difference in their DNA that can impact how they respond to common medications," said Emily J. Cicali, PharmD, a clinical associate at the University of Florida College of Pharmacy, Gainesville, Florida.

Cicali is the clinical director of UF Health's MyRx, a virtual program that gives Florida and New Jersey residents access to pharmacogenetic (PGx) tests plus expert interpretation by the health system's pharmacists. Genetic factors are thought to contribute to about 25% or more of inappropriate drug responses or adverse events, said Kristin Wiisanen, PharmD, dean of the College of Pharmacy at Rosalind Franklin University of Medicine and Science in North Chicago, Illinois.

"Pharmacogenetics helps consumers avoid drugs that may not work well for them or could cause serious adverse events. It's personalized medicine," Cicali said.

Through a cheek swab or blood sample, the MyRx program — and a growing number of health system programs, doctors' offices, and home tests available across the United States — gives consumers a window on inherited gene variants that can affect how their body activates, metabolizes, and clears away medications from a long list of widely used drugs…

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NAHC, NHPCO to Merge, Dombi to Retire

McKnight’s Home Care | By Adam Healy

The National Association for Home Care & Hospice and the National Hospice and Palliative Care Organization are on track to begin merging by July. In a related development, NAHC’s president William Dombi disclosed that he intends to retire by the end of 2024.

“Both boards have authorized an affiliation agreement; it’s fully drafted,” Ken Albert, chair of NAHC’s board of directors, told McKnight’s Home Care Daily Pulse in an interview. “We’re looking to transition July 1 of this year. The transition board has been selected. I’ll serve as chair of that transition board; [NHPCO board chair] Melinda Gruber will serve as vice chair. Board members have been identified, and then that next six months from July to December will kind of be the operational integration. We’re in the process of recruiting a new CEO right now, and then all the tech-side, the backend, office-end, that’s going on right now.”

Albert added that neither Bill Dombi or Ben Marcantonio, NHPCO’s chief executive officer, would be eligible to lead the new organization. However, Dombi may remain associated with the new organization in some capacity, he said.

“His title with [the new organization] is ‘president emeritus and of counsel,’” Albert said. “So he’ll continue to stay on as the new counsel for us and really in an advisory capacity with regard to the new organization as that transition is over in 2025.”

The current merger between NAHC and NHPCO represents the organizations’ fourth time attempting to combine. They have previously stated that a merger would help create a “unified voice” advocating on behalf of the home health, home care and hospice industries.

Dombi’s impact on the sector cannot be understated, Albert added.

“He’s contributed to the healthcare sector — particularly the post-acute, home health and hospice sector — for almost 40 years. It’s a huge part of who he is professionally,” he said. “Bill Dombi deserves to be celebrated for his contributions to the industry, and as the NAHC board winds down, we have an ad hoc committee that has been working to identify opportunities to acknowledge his contributions and celebrate him as NAHC winds down and becomes the new organization.”

 
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