News from the End of Life

NHPCO to offer manager program

The National Hospice and Palliative Care Organization (NHPCO) in Alexandria, VA, has launched a new training program designed for hospice professionals. The Hospice Manager Development Program (Hospice MDP) will not only expand current knowledge but will also provide an intensive training program rooted in hospice values, NHPCO officials said in a press release.

State-of-the-art, hospice-specific tools will be used to develop additional skills for managers to meet today’s challenges. The program, the first of its kind, combines the latest innovations in audio and web-based learning with the benefits of classroom training.

"The presence of learner-focused hospice and palliative care training reflects NHPCO’s commitment to meet the demands of hospice professionals," commented J. Donald Schumacher, PsyD, NHPCO president and CEO. "With this exciting new program we are responding not only to the current needs of hospice and palliative care managers but better preparing them to assist patients and families. The Hospice MDP is an investment in the future of hospice and palliative care."

Highlights of the program include personal access to national hospice experts, opportunities to achieve three levels of designation, centralized training locations, and the opportunity for past participants to become involved as a trainer.

For more information, call the NHPCO Professional Education Office at (703) 837-1500.

Hospital to pay $9.5M for Medicare billing issues

A hospital in Greenville, SC, will pay nearly $9.5 million to resolve Medicare billing improprieties from 1997 through 1999 in its home health, hospice, and durable medical equipment programs, the Office of Inspector General (OIG) announced recently. The settlement is the largest reached in such cases. Acting principal deputy inspector general Dara Corrigan announced the settlement with St. Francis Hospital, which self-disclosed the improper billing.

When purchasing St. Francis in 2000, Bon Secours Health System discovered billing and documentation problems at St. Francis. Bon Secours then launched an internal investigation that revealed "significant error rates and systematic documentation lapses" in St. Francis’ Medicare billings, Corrigan says. The hospital brought its findings to OIG under the Self-Disclosure Protocol, which encourages providers to approach the government voluntarily when they uncover evidence of potential fraud and compliance problems in their organizations.

Under the Self-Disclosure Protocol, OIG outlines how providers should investigate and audit compliance problems and how OIG will work with disclosing providers to resolve the situation. Corrigan says St. Francis was subject to much higher penalties than the settlement amount, but because the organization self-disclosed and quickly took corrective steps to remedy the problems, the OIG took a cooperative approach to remediation.

Two-page advance beneficiary notice gone

Throw away the two-page advance beneficiary notice that you’ve had the option of using since 2002.

The Centers for Medicare and Medicaid Services has said the only advance beneficiary notice it will accept is the single-page notice (CMS-R-296). The form, used to tell beneficiaries they are refusing or reducing physician-ordered care, can be accessed at Scroll down to Home Health Advanced Beneficiary Notice. You can access the form and instructions for it in English and Spanish. This requirement applies to services ordered on or after Jan 1.

CMS describes HIPAA authorization form

The Centers for Medicare & Medicaid Services (CMS) is offering a preview of a privacy authorization form that includes the core elements and necessary statements required in the privacy rule of the Health Insurance Portability and Accountability Act (HIPAA).

CMS is in the process of developing a standard authorization form for Medicare beneficiaries to use. Although the form will not be available for several months, the program memorandum offers a guide to the elements necessary for a valid privacy authorization.

The core elements of a valid authorization must contain at least the following elements:

  • a description of the information to be used or disclosed that identifies the information in a specific and meaningful fashion;
  • the name or other specific identification of the person(s), or class of persons, authorized to make the requested use or disclosure;
  • the name or other specific identification of the person(s), or class of persons, to whom the covered entity may make the requested use or disclosure;
  • a description of each purpose of the requested use or disclosure. The statement "at the request of the individual" is a sufficient description of the purpose when the beneficiary initiates the authorization and does not, or elects not to, provide a statement of the purpose;
  • an expiration date or an expiration event that relates to the individual or the purpose of the use or disclosure;
  • the signature of the individual and date. If a personal representative of the individual signs the authorization, a description of such representative’s authority to act for the individual also must be provided. Although the HIPAA Privacy Rule only requires a description of the representative’s authority to act for the individual, CMS requires that documentation showing the representative’s authority, such as a Power of Attorney, be attached to the authorization.

The memorandum also includes examples of wording that may be used to place an individual on notice that he or she can revoke the authorization and to inform the individual of the process that must be followed to revoke authorization.

The program memorandum can be accessed on the CMS web site at:

Prescriptions blamed for dependencies

The Waismann Institute in Beverly Hills, CA, has released findings of its 2004 Opiate Dependency Report, which shows that 56% of patients’ opiate dependencies began with medication prescribed by their doctors, reported in March.

The findings are based on a survey of patients receiving treatment for dependency on opiates such as prescription painkillers Lortab, Vicodin, and OxyContin, and the illegal narcotic heroin.

"The results of our 2004 Opiate Dependency Report indicate that there is a challenge faced by doctors treating patients in the evolving field of pain management," says Clare Waismann, executive director of The Waismann Institute.

"The survey shows how painkiller dependencies often begin with a legal prescription to treat pain, and then the brain unsuspectingly develops a chemical reliance on the drug. These are not people who indulged in recreational drug use to achieve a high."

The Waismann Institute’s 2004 Opiate Dependency Report also reveals that 53% of patients who were dependent on a prescribed medication did not ask for assistance from the prescribing doctor to get off the drug after the patient realized he or she was dependent.

The study also found that 14% of dependent patients visited multiple doctors to obtain their drugs. Also, for the majority of dependent patients, the survey results indicated that dependency on prescription pain medication was their only experience with a drug dependency. Fifty-three percent of drug-dependent survey respondents reported they had never experienced dependency issues with any type of illegal drug.