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Hospices nationwide that care for Medicare beneficiaries have until Dec. 2 to be compliant with a new set of regulations, the first Medicare update regarding end-of-life care since 1983.

“One of the hallmarks of hospice care in the past has been that the patient is, of course, the center of care and is active in the decision-making process, but these regulations do make that even more clear,” said Karen York, executive vice president of organizational excellence and mission at Nashville-based Alive Hospice, a nonprofit organization that provides compassionate end-of-life care and bereavement support services in 12 Middle Tennessee counties.

The hospice industry is applauding the new guidelines, called the Medicare Conditions of Participation(CoPs), which mandate a universal standard of care for hospices across the nation to ensure quality and consistency. The new regulations have a strong focus on patient-centered care that emphasizes quality assessment, performance improvement and patient outcomes.

According to York, some of the most notable changes include:

• An initial assessment of a patient’s immediate needs must be completed by a registered nurse within 48 hours of the patient’s electing to receive hospice care. A comprehensive assessment by members of the hospice interdisciplinary team must occur within five calendar days. The hospice team includes a physician, nurse, social worker, certified nurse technician and chaplain. York noted that this is an assessment of all the patient’s symptoms, “whether it’s physical, whether it’s spiritual, psychosocial or daily needs, because we do offer all of those things through hospice care.”


• The interdisciplinary team must continually review and update the patient’s plan of care no less than every 15 days.


• Hospices must have a comprehensive, data-driven quality assessment and performance improvement program to ensure optimal patient safety and outcomes. The program must track adverse patient events, analyze their causes, implement preventive actions and measure its success to ensure that improvements are sustained.


• Hospice social workers must have a master’s degree in social work; have a bachelor’s in social work and one year of experience in healthcare, supervised by someone with a master’s; or have a bachelor’s and be employed prior to Dec. 2, 2008.


• Criminal background checks are required for any staff with direct patient contact or access to clinical or financial records. This includes paid and contract staff as well as volunteers.

York said Alive Hospice already has met most of these new obligations. That’s one reason the organization is working with the Tennessee Hospice Organization to help educate other Middle Tennessee hospice providers about the revised guidelines. “Right now we are in an evaluation process. We’re learning as much as we can, evaluating what we have and what we may need to change. I would imagine that’s probably where most hospices are right now,” said York, who along other members of the Alive Hospice team attended a two-day training session in June in Baltimore, sponsored by the National Hospice and Palliative Care Organization.

NHPCO President and CEO J. Donald Schumacher said the new guidelines had been “eagerly awaited” by the industry. “The new CoPs will ensure a framework of quality that benefits patients, families and the organizations providing care at life’s end. The new CoPs along with tools and resources available from NHPCO will help all providers continue to strive for the highest levels of quality and access,” he said.

York anticipates that the new CoPs will boost confidence in the hospice industry, especially from physicians and other healthcare providers. “This will help raise the awareness of hospice. It gives us a lot of opportunity as these new regulations will be coming into effect to go out once again and educate and talk to our partners in the community about what hospice can provide and how these regulations will help their patients as well,” she said.

It’s “an exciting time” for the hospice industry, she added, saying that the new guidelines are “good news for hospices from our perspective and for the care that will be delivered. I am very thankful for Medicare and the way these regulations have come out, because I do believe they focus on where the focus needs to be. The regulations make sense for us, and they support what we’re already doing, helping to raise the bar nationally for hospice care.”



August 2008

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