Eli's Hospice Insider

Hint: The provision is also in the proposed annual hospice payment update.

At press time, the National Hospice and Palliative Care Organization's public policy committee hadn't met to officially consider the Rockefeller end-of-life care legislation in the Senate (see the cover story). Even so, Jon Keyserling, VP of public policy and counsel at the organization, says he's "very confident" the organization will strongly support the senator's efforts.

The NHPCO's support isn't, however, carte blanche. "There is one provision in particular that we feel might have a potentially negative impact on referrals to hospice programs," says Keyserling. And "that's the bill's inclusion of the MedPAC recommendation requiring both the patient's attending physician, and the hospice physician to include a specific narrative supporting hospice eligibility in the initial certification."

The same provision is in the proposed hospice payment update, although it isn't yet a done deal, given that the Centers for Medicare & Medicaid Services is required by law under the administrative procedure act to consider comments, says Keyserling.

Enough already: Current hospice certification is already required to include clinical information and other documentation in the medical record to support the medical prognosis, Keyserling points out. And "roughly 30 percent of hospice patients die within seven days -- and half die within 21 days [after going on the hospice benefit]." Thus, it's unacceptable to have any additional mandates duplicating existing requirements that impede "speedy referrals of otherwise appropriate and eligible hospice patients," he says.