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The Monthly Membership Publication of the National Hospice and Palliative Care Organization December 2012 Inside Succession Planning: It May Not Be About Filling the Current CEO’s Shoes For many hospices, the current CEO’s skill set may not be what the organization needs to advance its future goals. That was Laura Miller’s determination–and her recommendation to the board of The Elizabeth Hospice–when she retired as president/CEO in June of 2012. In this Q&A, Laura explains the plan and the process for a seamless transition. Hospice in the Continuum In September, Hospice & Palliative Care of Cape Cod underwent a comprehensive rebranding initiative, changing its name to HopeHealth to better reflect its expansion of services and geographic footprint. That growth has included the introduction of a home-based primary care practice called Hope HouseCalls. In this Q&A, chief growth officer, Lise Lambert, discusses the new program. Managing Accountability When the managers and leaders in the NCHPP Clinical and Operations Management Section were asked what their greatest challenge was, their overwhelming response was managing accountability. Section leader, Bridget Montana, shares a four-step strategy that she has personally found to be effective. NHPCO Honors Exemplary Hospice Service A Message From Don Member News and Notes Compliance Tip Videos Worth Watching Winning Entries From the 2012 Creative Arts Contest! When will we ever learn? How many times have you sat on the fence concerning an important decision or looming deadline that you just couldn’t bring yourself to address? It is an experience we can all relate to even though we also know that postponing the big decisions and difficult tasks is usually a recipe for disaster. One of the most disastrous examples of this that comes to my mind was the case of Terri Schiavo. As Terri lay dying in a Florida hospice, the Supreme Court, Congress and the entire country debated her fate because she hadn’t made her end-of-life preferences known to her entire family. The Schiavo/Schindler conflict was the ultimate illustration of what can go wrong when this difficult task is not addressed, when a family member’s wishes are not shared or documented. Yet, despite all the media attention surrounding this case, a PEW survey conducted less than a year after Terri’s death found that only 30 percent of Americans had completed an advance directive. Can the barriers to advance care planning ever be overcome? continued on next page Conversations Before the Crisis: Reframing Advance Care Planning By Kathy Brandt, MS

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The Monthly Membership Publication of the National Hospice and Palliative Care Organization December 2012

InsideSuccession Planning: It May Not Be About Filling the Current CEO’s ShoesFor many hospices, the current CEO’s skill set may not be what the organization needs to advance its future goals. That was Laura Miller’s determination–and her recommendation to the board of The Elizabeth Hospice–when she retired as president/CEO in June of 2012. In this Q&A, Laura explains the plan and the process for a seamless transition.

Hospice in the ContinuumIn September, Hospice & Palliative Care of Cape Cod underwent a comprehensive rebranding initiative, changing its name to HopeHealth to better reflect its expansion of services and geographic footprint. That growth has included the introduction of a home-based primary care practice called Hope HouseCalls. In this Q&A, chief growth officer, Lise Lambert, discusses the new program.

Managing AccountabilityWhen the managers and leaders in the NCHPP Clinical and Operations Management Section were asked what their greatest challenge was, their overwhelming response was managing accountability. Section leader, Bridget Montana, shares a four-step strategy that she has personally found to be effective.

NHPCO Honors Exemplary Hospice Service

A Message From Don

Member News and Notes

Compliance Tip

Videos Worth Watching

Winning Entries From the 2012 Creative Arts Contest!

When will we ever learn?

How many times have you sat on the fence concerning an important decision or looming deadline that you just couldn’t bring yourself to address? It is an experience we can all relate to even though we also know that postponing the big decisions and difficult tasks is usually a recipe for disaster.

One of the most disastrous examples of this that comes to my mind was the case of Terri Schiavo.

As Terri lay dying in a Florida hospice, the Supreme Court, Congress and the entire country debated her fate because she hadn’t made her end-of-life preferences known to her entire family. The Schiavo/Schindler conflict was the ultimate illustration of what can go wrong when this difficult task is not addressed, when a family member’s wishes are not shared or documented.

Yet, despite all the media attention surrounding this case, a PEW survey conducted less than a year after Terri’s death found that only 30 percent of Americans had completed an advance directive. Can the barriers to advance care planning ever be overcome?

continued on next page

Conversations Before the Crisis:

Reframing Advance Care PlanningBy Kathy Brandt, MS

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Hospices have long played an integral role in educating communities about the importance of advance care planning and teaching people how to complete the legal documents.

To increase awareness at the national level, a coalition of national, state and community organizations, including NHPCO and many state organizations and local hospices, also came together to create National Healthcare Decisions Day (NHDD) on April 16. This past April marked NHDD’s fifth-year anniversary and drew participation from more than 110 national organizations and 1,100 state and local organizations which participated in events to increase awareness.

Even with this national effort, however, the percentage of Americans who have completed advance directives still hovers between 25 and 30 percent of the nation’s adult population. This begs the question: What will it take to get every other adult American to complete his or her advance care directive?

The Known Barriers

The common barriers to advance care planning are both widely known and documented:

• Our death-denying culture

• A pervasive belief that advance care planning is for the very old and very sick

• Individual reluctance to discuss such an “unpleasant” or “uncomfortable” topic

• General confusion about the necessary documents—Living Will, DNR, Healthcare Surrogate, Advance Directive—as well as where to find them and how to complete them

• Unfamiliarity with the medical terminology

• Fear of receiving “no care” if a living will is signed

• Lack of trust that the document will be honored

• State-specific directives and laws which make portability of directives difficult

As NHDD shows us, even the presence of a diverse coalition of organizations working together to mitigate these barriers and increase understanding through a national day of awareness has not resulted in a higher completion rate. Given this, is it time to change our strategy?

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J. Donald Schumacher, PsyD

President/CEO

As the year comes to a close, I would like to thank each one of you who has done so much to support NHPCO throughout this busy year. You are a valued part of this

organization and I want to express our appreciation for being part of NHPCO—and the National Center for Care at the End of Life.

There seems to be many challenges and changes in our field—and in the world around us. But for every challenge, there is also opportunity. One thing that remains constant is the commitment to caring that you bring to every patient and family member that you serve.

We care for people on a daily basis at a time when compassion, dignity and excellence are needed most. I hope that every one of you finds the same peace and kindness that you so generously provide to the people you care for.

During this holiday season, I encourage you to cherish time spent with your families and loved ones. Enjoy the special gifts found in quiet moments of reflection and in unexpected acts of kindness. On a personal note, this holiday season will be a joyful one for my family as I welcomed my second granddaughter into the world only days before Thanksgiving.

A special thanks goes out to the NHPCO board of directors whose members do so much to help the entire hospice palliative care community. Specifically, I want to extend my appreciation to Mark Murray who has served as our board chair for the past two years. Fortunately, he will continue on in 2013 as the immediate past-chair, but for his many, dedicated years of service, please join me in thanking him.

On behalf of the NHPCO board, our staff and our affiliate organizations, I wish you a peaceful holiday season and a happy New Year!

Thank You

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Reframing Our Goal

As hospice professionals, we often talk about helping the patients and families we serve “reframe hope.” Perhaps we also need to “reframe success” when it comes to advance care planning. Rather than think about success as a percentage of Americans with an advance directive, what if, instead, we focused on and measured a more specific aspect of advance care planning? What if we focused our community-based advance care planning efforts on naming a healthcare surrogate? The reasons for doing so paint a persuasive picture.

In looking at the known barriers to advance care planning, focusing on the importance of naming a healthcare surrogate, and not on creating a living will, is probably far more palatable to many Americans and makes many of the other known barriers a non-issue.

For example, naming a healthcare surrogate is not directly tied to end-of-life care, but is appropriate for individuals having surgery, people with chronic conditions, and others. Thus, our “death-denying society” as well as the belief that advance directives are only for the “very old or

very sick” become non-issues. Since the healthcare surrogacy document doesn’t require individuals to make decisions about specific treatments, “understanding medical terminology” also becomes a non-issue.

If individuals name someone as their surrogate who has similar values or thoughts related to beginning, continuing, or stopping treatment, then the known barrier related to “fear of receiving no care” is also eliminated.

When it comes down to it, the piece of paper that lists treatment options (e.g., CPR or no CPR, artificial nutrition or not, artificial hydration or not) does not account for the endless number of subtleties that reflect the realities of the medical conditions that precipitate these decisions. No single document, no matter how it is structured and how many questions it asks, can anticipate the unique set of circumstances and the context of a complex, serious medical situation.

Naming a healthcare surrogate obviates the need to think about the many “what if’s” and how to document a person’s preferences

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(e.g., “try for a little while…”). Naming a surrogate is entrusting the decision making to someone who knows the individual well enough to make those decisions on his or her behalf. While it isn’t perfect (sure it would be better if the surrogate had the living will to guide every step), it is far better than doing nothing.

Putting the Idea into Action

Reframing our approach to advance care planning doesn’t require a change in the forms or documentation. It does require a change in the way we talk about this subject—and perhaps the language we use to describe the process.

What if we used the terminology of NHDD, referred to the process as making “healthcare decisions,” and encouraged people to just name a surrogate? Nothing more. No talk about resuscitation, tube feedings or ventilators.

If our presentations to community groups or at health fairs started and ended with, “Who would you want to make healthcare decisions for you in the event that you couldn’t talk for yourself?” The discussion could include what happens when a decision maker isn’t named, the qualities you should seek in an effective advocate, and how

to ask someone to be a surrogate. Wouldn’t that change the way people think about decision making? All we are asking them to do is name one person who they trust could speak to doctors if they are unable to.

The next time you are talking with a person or group about the topic, call it “healthcare decision making” and ask them to think about who in their circle of friends and family would make a good advocate—someone who could:

Ask their doctor questions without feeling intimidated or bothersome;

Talk to other family members who might have different opinions or questions, and can keep an even temper so as not to fuel disagreements;

Make decisions based on the individual’s values or beliefs—and always keeping that at the forefront of all healthcare discussions.

If you are able to engage a person or people in this discussion and you get to the point where you show them the document, you can mention the living will. Certainly tell them that they can complete it if they want, but that it isn’t required in order to name a surrogate.

What Do You Think

of the Author’s

Proposed Strategy?

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The last important step in this new approach—and any advance care planning discussion for that matter—is to encourage individuals to talk with their chosen healthcare surrogate, family members and friends to ensure that everyone knows who the primary decision maker is. And then, as we’ve always done when educating people about advance care planning, make sure they give copies of the documents to all parties who might need access to them in an emergency.

Kathy Brandt is senior vice president of NHPCO’s Office of Innovation and executive director of NHPCO’s Mary J. Labyak Institute for Innovation.

Resources:

Caring Connections

Choosing Wisely

National Healthcare Decisions Day

Coming April 23: Free ACP Symposium

Moderated by Eleanor Clift

On April 23rd, NHPCO president/CEO, Don Schumacher will be joined by Newsweek contributor, author and political analyst, Eleanor Clift, to moderate a free, half-day symposium on “Conversations Before the Crisis: The Intersection of Family, Faith and Policy in Advance Care Planning.”

The symposium will be held in Washington, DC, in conjunction with the NHPCO Management and Leadership Conference, and is being hosted by the NHPCO Hospice Action Network and the new Mary J. Labyak Institute for Innovation.

The event will include non-partisan panels comprised of policy makers, faith leaders, caregivers, hospice experts and journalists who will explore:

• Avoiding family conflict through advance care planning

• Exploring faith and spiritual aspects of end-of-life decision making

• Acknowledging the economic realities of providing care in the last years of life.

Mark your calendars and look for further details in January. Immediate questions can be directed to Cozzie King at [email protected].

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Choosing Wisely: An Opportunity to Expand the Conversation

Choosing Wisely is a national initiative that seeks to promote conversations between physicians and patients by helping patients choose care that is supported by evidence; not duplicative of other tests or procedures already received; free from harm; and truly necessary.

NHPCO is currently working with Consumer Reports, AARP and other groups to promote Choosing Wisely and inform consumers about lists of tests and procedures that patients and families should discuss to determine both their efficacy and the impact on a patient’s quality of life.

EOL Lists and Guidance in the Works:

In early 2013, the American Academy of Hospice and Palliative Medicine, the American Geriatrics Society and other medical specialties will be releasing new lists of evidence-based recommendations that patients and physicians should discuss to ensure that care decisions reflect the patient’s goals and individual situation.

Consumer Reports will take these lists and prepare easy to understand information that patients can use to engage their physicians in conversations and ask questions about what tests and procedures are right for them.

As part of this initiative, consumer-friendly resources related to care near the end of life will be developed.

Your Role:

When people understand what questions to ask their physicians, they are better prepared to make decisions about their treatments and, hopefully, also name a healthcare surrogate before they are faced with a crisis.

As part of your organization’s advance care planning outreach, please share this new resource with members of your community—and avail yourself of the materials as well! Choosing Wisely provides hospices with another series of tools to help reframe discussions about care decisions and empower patients.

Visit Choosing Wisely now.

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It May Not Be About Filling the Current CEO’s Shoes

Every organization needs a succession plan for its senior leaders. And as a relatively young industry, the need is far greater in the hospice field as our founding leaders approach retirement.

That said, it’s a challenging task which few hospices have actually addressed. For many, their leaders have become the very essence of their organization, so it’s hard to conceive of someone ever replacing them.

But maybe that shouldn’t be the goal? Maybe trying to fill the current CEO’s shoes may not be what the organization needs going forward?

That was Laura Miller’s determination—and her recommendation to the board of The Elizabeth Hospice—when she retired as president/CEO in June of 2012.

The Elizabeth Hospice, Inc. is a not-for-profit organization that was founded in northern San Diego County in 1977. It functioned as an all-volunteer organization until 1981 when its first employee was hired to provide direct care under a home-health agency license. In 1985, the organization affiliated with a local hospital system, and in 1989 Miller joined the organization as director of patient services. She was promoted to executive director in 1995, and when the affiliation with the health system ended in 2001, she was named the hospice organization’s president/CEO.

During her 23-year tenure, she accomplished many things. Under her leadership, The Elizabeth Hospice evolved from a grassroots program serving about 33 patients a year to a proactive, customer-driven organization with an

annual census of 430. What she’s most proud of, though, is the dedication and loyalty of the staff and volunteers—staff turnover is less than 12 percent a year and volunteer service awards are in the range of 30 years. But, despite these accomplishments, she came to the conclusion that the skill set which served her and her organization well over the past two decades was not the same skill set the future CEO would need.

Miller is now living in Boise, Idaho with her husband, Michael, and will serve as a consultant of special projects for the organization through the summer of 2013. In this interview, she talks about the process she and her board followed in selecting a new CEO (hospice veteran Jan Jones) and in making related changes that have resulted in a smooth transition.

Succession Planning:

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When did you decide to retire, and how did you handle notification to the board and staff?

In 2006, following the deaths of both my mother and mother-in-law, my husband and I discussed our goals for the future. It was at that time that I decided I would retire in 2010—I would be 60 and Mike would be 66—but I kept the decision to myself.

As the time approached, however, I decided to delay my retirement. There were several challenges facing the organization around that time and leaving the hospice stronger than it had ever been was a personal commitment of mine. So I did discuss my retirement plans with the board’s Executive Committee in November of 2010, but with a plan to retire the following year.

When my retirement was announced to the senior leadership team and the hospice’s full board in November of 2011, the hospice was well on its way to achieving the goals set for census, market share, cost-per-patient day, and employee turnover. Staff morale was also high, as reflected in the employee engagement scores of our STAR report. So I felt good about the timing and the decision to wait. I shared the news with our entire staff on January 1, 2012 in my New Year’s memo to them.

Did the organization have a formal succession plan in place?

Yes. While working with the board’s Executive Committee on planning their annual retreat in January 2007, I had suggested that they look at succession planning. I had already begun looking at planning for the hospice’s key positions and wanted the board to begin thinking about the CEO position.

As a first step, we invited Michael Covert, CEO of the Palomar Pomerado Health System, to attend the retreat and discuss the planning process he had initiated for the health system’s board. The key takeaways from his discussion were the need to develop a plan in conjunction with defining the organization’s strategic goals and to develop the plan well before the need to fill a vacancy arises.

So a committee was created, comprised of members of our hospice board and foundation board. The group was charged with defining the CEO succession process, including the development of an emergency transition plan and review of the CEO position description and annual evaluation process. I worked closely with the committee, providing resources I had obtained through the Nonprofit Management Resource Center and Board Source as well as through my own experience while

Succession Planning:

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serving on the California Hospice and Palliative Care Association’s CEO Selection Committee.

The full board approved the succession plan in September of 2009.

But you ended up making substantive changes to that succession plan?

Yes we did, as part of the organization’s strategic planning process in 2010. Doing so during this planning process proved to be very helpful.

By then we had successfully addressed the challenges that had been facing the organization and had compelled me to delay my retirement, namely an extensive Total Medical Review process and the resultant need to adjust our daily census downward. It was time to look at our future goals.

We were introducing a rebranding project and implementing some aggressive marketing strategies around this time. Additionally, we were partnering with the Studer Group to assist us in leader development and in navigating an organization-wide initiative we had named “Journey to Excellence.”

This process was producing interesting data that was prompting us to take a deeper look into how we conducted business, so it was

an excellent time for me to discuss the leadership qualities I felt would be necessary to achieve our future goals—for both the CEO and other leadership roles.

Part of this planning process involved a formal assessment. Can you talk about that?

We conducted an institutional assessment that consisted of a series of questions in seven areas—mission, vision, financing, governance, management, communications, and institutional culture. The majority of these questions were being addressed during the strategic planning process, but there were several general questions which needed to be addressed in the succession planning process. The answers to those questions helped us to identify the desired skills, characteristics and competencies to be outlined in the revised CEO position description.

What did the assessment reveal?

It verified a few key areas that I and the senior leadership team knew we needed to address. Time and resources needed to be put into long-range planning in addition to dealing with the daily crises. While our primary focus had been on our relationship with Medicare and our compliance with the Hospice CoPs, we needed to build on our nonprofit mission within the

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I presented position

descriptions for both

a COO and CEO…

community. We were growing with two distinct identities and each one needed short- and long-term guidance from the senior leaders and the board of directors. A “vision” needed to be agreed upon by the board and senior leaders and then communicated throughout the organization. The decision was made to both grow the hospice census and invest in the development and expansion of programs at The Center for Compassionate Care.

Can you discuss the position changes that were made in response to the assessment, including what the skill set and focus of the new CEO would be?

The Elizabeth Hospice has always been more than the Medicare Hospice Benefit in our community. We are known for our vast offerings in counseling, bereavement and grief-support programs, which are provided through The Center for Compassionate Care.

Because of this increased visibility, we have experienced a demand for end-of-life programs beyond the confines of Medicare’s six-month prognosis. At the same time, and as a result of the marketing efforts, our census was growing in underutilized sections of our service area. With the growth in census and increased demand for community based

programming, additional staff was needed. Recruiting goals were established and staff searches were aggressively implemented.

In light of this, I needed to rethink the hospice’s leadership structure. We absolutely needed people to lead staff through the day-to-day issues and challenges, but we also needed people to think strategically and creatively.

In analyzing where I was placing my time and resources, it became clear to me that I was not spending my time where I needed to achieve the organization’s goals. The entire senior leadership team of eight people reported to me, keeping me in the “operations mode” for the majority of time. I was not spending the time to cultivate new relationships or forge new partnerships. While operations and development of senior staff were my strength and what I truly enjoyed, a change was needed. I was at the juncture where I realized the board needed to look at the CEO position differently.

I discussed this analysis with the board’s Executive Committee and presented them with position descriptions for both a COO and CEO. An organizational chart outlining the lines of accountability was also presented to aid in the discussion. The COO position would have five direct

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reports while three senior leaders would report to the CEO.

The COO position was approved and implemented in September of 2011, two months before I disclosed my retirement plans to the full board and senior leadership team. We were fortunate to have several candidates, internal and external, from which to choose. Andrea Goodwin, our then-current HR director was ultimately selected, and functioned in a dual role as COO/HR director until September 2012, at which time an external candidate was hired to fill the HR role.

The revised CEO position description called for such characteristics as naturally creative, entrepreneurial, and eager to find innovative ways to launch and sustain new programs and services. The new CEO would have a strong public presence and the ability to represent the hospice effectively before a wide range of audiences. These qualities would address the organization’s need to have a “face” in the community, someone who could increase public awareness of the issues around end-of-life care and serve as the chief spokesperson and advocate for the hospice’s mission, programs and services.

How were you able to articulate, to the staff and board, that the organization really needed a different type of leader for the next generation?

I think that was communicated quite effectively through the actual planning processes.

Once the organization’s strategic goals had board approval, we asked ourselves how the goals were going to be achieved and who was going to get us there.

I, along with the senior leadership, had completed a self-assessment where our strengths and weaknesses were delineated. The hospice’s management staffs were also all enrolled in the Leader Development Institute through our partnership with the Studer Group, so they could develop the skills they needed to effectively hold one another, along with their staffs, accountable to the desired outcomes. It was communicated to all staff that the hospice was looking for and developing leaders who would be held accountable to achieving the identified goals which would separate us from other providers.

Informational meetings, along with presentations by the Studer Group, were held with the board and senior leaders. These meetings helped identify what we needed from our current and future leaders in order

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to achieve our short and long term goals. It was also through this process that the skills needed by the next CEO were identified. The board members began to explore the idea that they were not looking to replace me with me, but were indeed looking for a different type of leader.

Our internal communication centered on the theme of our organizational initiative, “Journey to Excellence.” All the projects we initiated were directly related to our journey. Board members attended the all-staff meetings to discuss their role in the journey and to answer questions from staff.

By the time the full board and staff learned of my retirement, they had already been prepped for the various changes necessary and were acquainted with the notion that a new type of leader would help the organization continue to grow and excel.

What did you find most valuable about the succession planning process?

Succession planning is not done in a vacuum. It is truly a process with multiple layers. I think the most important part of the process is its linkage to strategic planning. Where are we going? How are we going to get there? These are questions that need to be answered. Like strategic planning,

succession planning needs to be dynamic. It is not a written document that is shelved, but something which is integral to the organization. Succession planning isn’t just something we did for the CEO position. We extended the process throughout the senior leadership group and to other key positions within the organization. We found this process important as we began the formal process of leadership development. Each leader is always asked two questions: Who can be moved into your position should there be a temporary vacancy? What are you doing to prepare them for that?

Was the hospice team involved in the transition? And if so, in what ways?

Absolutely. Two of the senior leaders, along with the executive assistant, participated on the board’s Selection Committee for the new CEO. These leaders kept the rest of the senior leadership informed of the process. They also held forums where staff could voice their concerns and desires.

What was the internal focus of support for the current staff during the transitional period?

Once the announcement of my retirement was made to staff, the board’s Selection Committee communicated the process during an all-staff meeting. A timeline to fill the position was shared

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and updates were provided both in writing and during subsequent team meetings. The board retained The Corridor Group to conduct an executive search since it was important to me and to the board that staff understood this process warranted a nationwide search—that it was part of our commitment to the “Journey to Excellence.” The new CEO would be expected to carry forward on the path we all were travelling.

Looking back, would you have done anything differently?

While this was certainly a learning exercise for all of us, I would say no. I would also expect the board and staff to have the confidence and trust in one another that when the time comes again, they have a solid plan to follow.

What general advice would you give a hospice provider?

Have an effective employee evaluation and development process. Build on strengths. Look for informal leaders and develop them. And continuously evaluate your strategic plan and make sure you have the right people in place to achieve your goals.

Any particular guidance for the leader of a small hospice?

I don’t think size is an issue. Every hospice leader owes it to his or her stakeholders to have a succession plan in place, even if it just covers a temporary absence. Plan your exit. It is easier to plan it out thoughtfully and tweak it as necessary than to fill a position in an emergency.

Last but not least, how’s retirement going? How did you actually accomplish “moving on” from a leadership role?

I’m loving it! It still feels like one extended vacation. Right now, all my energy is being spent on setting up our new home and learning our new community. I miss the staff and volunteers of The Elizabeth Hospice, but I don’t miss the sleepless nights! I have had a wonderful career in healthcare and the past 23 have been the best of my life. But now I am ready to learn fly fishing!

Resources:

Nonprofit Management Resource Center

The Board’s Role in Securing Your Organization’s Future by Nancy R. Axelrod (2002).

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Above: Senior leaders and the board of The Elizabeth Hospice at a retreat in January 2012, with Laura Miller (second row, center), who is wearing one of their retirement gifts to her—a top-of-the-line fly-fishing vest! At left: Laura and her husband, Michael, in their new home in Boise, with their dog Maggie and granddaughter, Teagan.

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16 NewsLine

NHPCO Honors Hospice Service

NHPCO and affiliate, the National Hospice Foundation, honored excellence in volunteerism, research, and

access at its Clinical Team Conference in November. For the benefit of those members unable to attend, join

us in recognizing the five award recipients.

Volunteers are the Foundation of Hospice Award

This award recognizes those volunteers who have demonstrated considerable commitment in terms of time, length of service and assumed responsibilities, while also strengthening the organization or making a notable impact on the lives of patients and families.

Patient/Family Service:

Chuck MirasolaVA Hospice and Palliative Care Unit Bay Pines, FL

L to R: NCHPP Vice Chair Rex Allen; Chuck Mirasola; NHPCO Board Chair Mark Murray; and NHPCO President/CEO Don Schumacher.

Organizational Support:

Richard W. Jett, Jr., CPAHospice of East Texas Tyler, TX

Richard Jett delivering his acceptance speech.

Teen Service:

Deanna WrightHospice and Palliative Care of Western Colorado Grand Junction, CO

Deanna Wright receiving her award from NCHPP Vice Chair Rex Allen.

Learn about these volunteers’ contributions.

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NewsLine 17

NHPCO Honors Hospice Service

Distinguished Researcher Award

This award honors substantial and sustained contributions to the field of hospice and palliative care through research investigation.

Holly G. Prigerson, PhDAssociate Professor of Psychiatry, Harvard Medical School

Director, Center for Psycho-Oncology and Palliative Care Research Dana-Farber Cancer Institute

Inaugural Access Award

The Advancing End-of-Life Care Access Award recognizes provider initiatives that have significantly increased the type, scope, or range of services offered to and used by a traditionally underserved population.

VITAS Innovative Hospice Care of DaytonDayton, OH

We Honor Veterans Level Four Partner

Don Schumacher with Holly Prigerson. L to R: Don Schumacher; General Manager of VITAS Dayton, Kim Vesey; and NHPCO Board Vice-chair Ron Fried.

Learn about Dr. Prigerson’s contributions.

Learn about VITAS of Dayton’s contributions.

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In this monthly feature,

NewsLine shines the

light on a hospice

organization which

has expanded services

or has partnered with

other community

organizations to reach

patients earlier in the

illness trajectory—

before they may need

hospice care. In a

Q&A format, members

hear firsthand from

the organization’s

senior leaders who

speak directly to

the challenges, the

benefits, and the

lessons learned.

18 NewsLine

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NewsLine 19

In September of this year, Hospice & Palliative Care of Cape Cod underwent a comprehensive rebranding initiative, changing its name to HopeHealth. The HopeHealth brand reinforces the non-profit’s 30-year year legacy of providing services to enhance quality of life for people experiencing serious illness and loss, while also reflecting an expansion of services and geographic footprint. “It’s a better reflection of our longstanding mission and our recent growth and evolution,” says chief growth officer, Lise Lambert.

That growth has included the expansion of hospice services from one to six counties; an affiliation with the local dementia and Alzheimer’s services organization; and the introduction of a home-based primary care practice called Hope HouseCalls. As a result, HopeHealth now serves significantly more people with chronic and serious illnesses. The organization has grown from caring for about 80 patients and families per day to 450 per day.

In this interview, Lambert discusses the Hope HouseCalls program.

The physician house call model has been gaining recognition around the country as an effective way to reduce rehospitalizations. What prompted your organization to establish your own program?The introduction of Hope HouseCalls is entirely in keeping with our long-term strategic plan to broaden our services to address the unique needs of our aging population. As people are living longer, many of them are living for years with multiple chronic conditions.

continued on next page

Quick Facts About HopeHealth

• Founded in 1981.

• Serves Eastern Massachusetts.

• Family of services includes:

Hope Hospice, including the McCarthy Care Center (inpatient care)

Hope HouseCalls (home-based primary care)

Hope Dementia & Alzheimer’s Services (assessment, care plan development and support)

Hope Care for Kids (pediatric palliative and hospice care, bereavement and counseling)

Hope Community Care (individual and group bereavement and counseling services)

Professional Education and Training (for healthcare partners and providers).

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20 NewsLine

continued from previous page

Patients with chronic illness, especially those with limited mobility or cognitive impairments, often lack regular access to primary care. Left untreated, their conditions worsen until they become acute and require emergency care or hospitalization, which are both traumatic and costly.

This is especially true on Cape Cod, which has one of the oldest populations in the country. Here on Cape Cod, there are estimated to be over 10,000 people living with some form of Alzheimer’s or other dementia and over 5,000 who are considered homebound. In the other counties we serve, there is estimated to be an additional 35,000 homebound people.

Hope HouseCalls is expressly designed to care for this high-risk population—for those who have difficulty or may even find it impossible to get to the doctor’s office. This kind of personalized home-based care is documented in national studies to improve outcomes and result in substantive savings.

These same patients consume a disproportionate share of healthcare resources—and they comprise the fastest growing segment of the U.S. population. According to the Congressional Budget Office, 5 percent of these chronically ill Medicare beneficiaries account for more than 43 percent of costs, and 25 percent account for 85 percent of costs. For non-Medicare patients, the challenge is the same: 10 percent of health plan members consume greater than 50 percent of the health plan costs.

Data increasingly demonstrates the cost effectiveness and greater patient/physician satisfaction of home-based primary care. According to the American Academy of Home Care Physicians, house calls prevent unnecessary and far-more-costly ER visits and hospitalizations. At $1,500 per ER visit, the cost of 10 house calls is offset by the prevention of one ER visit. Some programs have demonstrated as much as 65 percent reductions in hospital days and as much as 50 percent in cost savings.

Can you briefly describe the service model and how it is staffed?Our physicians visit patients in their homes, whether in private homes, assisted living facilities or other residential communities, and provide

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NewsLine 21

non-emergency, comprehensive primary care. Goals are to coordinate overall care, to provide single-point medication management, to improve overall health, and to reduce unnecessary hospitalizations and ER visits.

HouseCalls visits can be made on an interim basis and coordinated with a patient’s existing primary care physician, such as post discharge from a serious surgery when the patient cannot easily travel to the doctor’s office. Or, visits may be provided on an ongoing basis, with our physicians assuming the continual role as the primary care physician. In many cases, the patients we are seeing have no existing primary care physician, so we often fill that role.

In addition to the physicians, the practice is staffed by a general manager and a scheduler/office manager. Nurse practitioners will be added in the future and teamed up with the physicians. Back office and other administrative functions are provided by HopeHealth, leveraging organizational overhead.

How did you fund the start-up costs?The program is being funded through HopeHealth’s financial reserves. Operational start-up costs are estimated to be $500,000, with the majority of funding required in the first year. We are also seeking philanthropic support to offset the start-up costs.

How are the services paid for?The visits are covered by Medicare, Medicaid and commercial insurers, and patient co-pays apply just as they would for office visits.

Are you using an electronic health record?Yes. To ensure efficiencies in productivity and billing, and to enable us to begin tracking clinical and financial outcomes, using an electronic medical record is essential. Especially in light of the opportunity to align with new types of payor sources, such as Accountable Care Organizations (ACOs), Medical Homes and insurers, it’s critical to develop the ability to share health care information with other providers and payors.

continued on next page

Using an electronic

medical record

is essential…

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22 NewsLine

How are you building your referral base?We are leveraging our HopeHealth sales and marketing teams and functions to generate visibility with professional healthcare referral sources and community agencies. We are also beginning to develop contractual relationships with ACOs, insurers with dual-eligible programs, and Medicare Advantage plans.

What have been some of the challenges, if any, so far?The challenge in the start-up phase of a house call model is to develop geographic concentrations of patients. Developing concentration is important to productivity and adequate daily visit volume. Our target over the next year is to reach nine visits per day per physician. This will take some ramp-up time.

Are there any benefits to your hospice or other businesses?Yes. While HouseCalls serves people earlier in their disease processes, some of our HouseCalls’ patients will also be hospice-eligible. We also expect to identify HouseCalls patients who can benefit from our dementia and Alzheimer’s support services.

What’s next for HopeHealth?We are focused on advancing our mission to care for more people who need our services—by building our new brand, deepening our relationships with existing healthcare partners, and developing new types of relationships with emerging delivery models and payor sources.

continued from previous page

Are you offering a non-hospice service?

And would you like your work spotlighted in NewsLine?

Complete our brief questionnaire.

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How Can I Help Hospice?10 ways to make your difference.

National Hospice Foundation, 1731 King Street, Alexandria, VA 22314, [email protected], 1-877-470-6472 or 703-516-4928

For more information about our programs and how your contributions help, please visit:www.nationalhospicefoundation.org

Make a GiftDonate monthly or even once to support hospice and palliative care at www.nationalhospicefoundation.org/give.

Plan a Cause for CelebrationCollect donations for Veterans who have served our Nation, help children who need hospice and palliative care, or share copies of state-specific advance directives obtained through www.caringinfo.org with friends.

Run a Race — Solo or With FriendsRegister at www.runtoremember.org to honor a loved one and raise funds for the Foundation and a local hospice program.

Give at WorkAsk your human resources office if your organization matches charitable contributions or has another opportunity for you to donate with pre-tax dollars.

Designate Your Gift to Make a Difference in AfricaRaise money with family, friends and co-workers for FHSSA (which began as the Foundation for Hospices in Sub-Saharan Africa) — visit www.fhssa.org.

Choose Hospice as Your CharityMake a contribution to the Foundation in lieu of flowers or gifts for any occasion.

Include Hospice in Your WillLeave your legacy and create an effective plan for your future — visit www.nationalhospicefoundation.org/planning.

Shop OnlinePurchase gifts online with a portion of the proceeds to support national hospice — visit www.nationalhospicefoundation.org/shop.

Join Us for an Evening Celebrating HospicePurchase individual tickets or corporate sponsorships for our annual Gala at the Gaylord National Resort and Convention Center, National Harbor, Maryland — visit www.nationalhospicefoundation.org/gala.

Reserve a Space or Tribute Tile at the National CenterHonor someone you love or the caregiving team that made a difference at your loved one’s bedside — visit www.nationalhospicefoundation.org/capitalcampaign.

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24 NewsLine

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NHPCO’s National Council of Hospice and Palliative

Professionals (NCHPP) is comprised of 48,000 staff and

volunteers who work for NHPCO provider-members.

Organized into 15 discipline-specific sections that

are led by the NCHPP chair, vice chair and 15 section

leaders, NCHPP represents the perspectives of the

interdisciplinary team—the very essence of hospice care.

These individuals—together with each Section’s Steering

Committee—volunteer their time and expertise to a

variety of NHPCO projects to help preserve and develop

the “interdisciplinary model” within the evolving world of

hospice and palliative care.

In this NewsLine feature, we shine the light on a different

NCHPP Section each month, so all members can benefit

from each discipline’s perspective on important topics.

It will also help members learn more about the work of

NCHPP and how to get more involved—whether it’s taking

better advantage of some of the Section’s free activities or

joining a Section’s Steering Committee.

This month we spotlight the Clinical and Operations

Management Section, and an article by Bridget

Montana.…

NewsLine 25

continued on next page

Featured This Month:

Clinical and Operations Management Section

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26 NewsLine

W hat is a manager’s greatest hurdle to achieving success, especially in this

new era of massive collaboration?

When I posed this question to the managers and leaders in the NCHPP Clinical and Operations Management Section, their overwhelming response was “accountability”—that managing accountability was the major barrier to achieving their goals.

Much has been written on this topic over the years—on the difficulty of holding staff accountable and the ramifications of the failure to do so. In a survey of 400 business leaders conducted by OnePoint Consulting, 40 percent reported that the employees in their organizations are not held accountable for results.

Interestingly, many managers often look to someone else to take responsibility for being accountable, rather than taking the necessary steps to be more accountable themselves.

According to authors Chris McChesney, Sean Covey and

Jim Huling in their book, The 4 Disciplines of Execution, there are two principle areas a leader can influence when it comes to producing results: (1) the strategy or plan, and (2) the ability to execute the strategy. They also noted that most leaders reported “the ability to execute the strategy” to be the most challenging because their academic preparation was focused on strategy and not execution.

It has also been my experience that managers lack the skills or “know how” to manage employee accountability. Executing a strategy requires action and behavioral changes to attain specific results. Telling an employee to do something is usually inadequate because, oftentimes, the employee doesn’t understand what is expected or know how to proceed. I determined that a process was necessary for managers to follow as a recipe for successful execution.

In my work, I have found the following four rules recommended

Managing AccountabilityBy Bridget Montana, APRN, MS, FPCN, MBA

continued from previous page

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by McChesney, Covey and Huling to be quite valuable as that recipe for successful execution. These rules when followed, have created success. But in this case, the rules are not meant to be broken. When they are applied consistently and accurately, managers can obtain profound results.

1. Focus on the Wildly Important GoalsTraditionally, leaders thought the more goals they had, the better the chance for a successful organization. In reality, however, the more one tries to do, the less that is accomplished.

Following this rule allows you to have a laser-focus on a very important goal that is going to move the organization forward. It will help you move from a loosely defined and difficult-to-communicate list of objectives to a small, focused set of achievable targets.

2. Act on Lead MeasuresFirst, let’s define “measures.” In this context, the authors define two types: lag measures and lead measures.

Lag measures are the tracking measurements of the wildly

important goals. By the time you receive the results, the performance that drove the results is in the past; you cannot change or influence them. Lead measures are different in that they measure the new behaviors that will drive success on the lag measures. The behaviors can be simple or complex, but are usually predictive and can be influenced by the team members. For example, a patient who has lost 10 pounds is a lag measure; giving the patient high-calorie supplemental drinks and pureed food on a daily basis to assist him with swallowing is a lead measure.

This rule calls for identifying those steps (or lead measures) that will have the most impact on helping you achieve your goals—and focusing only on them.

3. Keep a Compelling ScoreboardPeople play differently when they are keeping score. Teams keep score on themselves. This improves personal accountability and improves engagement. Performance improves when there is an emotional connection to the work. It is important to let

NewsLine 27

Managing Accountability NCHPP Clinical and Operations Management Steering CommitteeSection Leader:

Bridget Montana [email protected]

Committee Members:

Theresa Brown Iowa Health Hospice – Taylor House Des Moines, IA

Janet Coleman Greenspring Village Hospice Springfield, VA

Susan Cox Hospice and Palliative Care of Greensboro Greensboro, NC

Barbara Ivanko West Palm Beach, FL

Hope Kurtz Valley Hospice, Inc Rayland, OH

Marci Pruitt Suncoast Hospice Clearwater, FL

Cindy Roche Family Hospice and Palliative Care Pittsburgh, PA

Niamh van Meines Practitioner Solutions River Edge, NJ

continued on next page

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28 NewsLine

the team devise and oversee the scoreboard. Keep it simple and clear to determine if the team is winning or losing.

4. Create a Cadence of AccountabilityThis rule calls for holding regular, frequent and brief meetings with the team that owns these wildly important goals. At each meeting, each member of the team must answer the question: “What are the one or two most important things I can do next week (outside the whirlwind) that will have the biggest impact on the scoreboard?”

Following this rule creates a regular, “just in time” execution plan that adapts to unforeseen challenges and opportunities. When the team sees the lag measure of a big goal move as a result of their effort, they will know they are winning. This impacts morale and engagement.

This is obviously where the execution also happens. Following the first three rules sets up the game, while this fourth rule puts you in the game. It is where accountability lives.

In SummaryI have found the power of this system comes from following all four rules. And, while they may seem fairly simple, they are not that easy to do consistently. It requires sustained commitment and a culture of cadence to penetrate an organization.

Recently there has been a significant amount of chatter from hospice leaders who are struggling with maintaining the culture of their organizations through this period of inflection in the healthcare industry. This four-step process is a great tool to use as it will provide a laser-sharp focus on the organizational goals and resources necessary to achieve success. Moreover, it will provide a method to ensure that the organizational culture is maintained as it unites team members with a clearer vision and instills a passion for success. Employee engagement is maximized.

To ensure success, sufficient time and resources need to be dedicated to educating managers and staff. Remember too that these are not guidelines, but a

continued from previous page

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NewsLine 29

set of disciplines which, once anchored in the organization, will return high dividends. Leaders and managers will no longer say accountability is a challenge to their success. Rather, the cadence of accountability creates the natural recurring cycle of planning and execution which, in turn, gets things done as promised.

Bridget Montana is the NCHPP Clinical and Operations Management Section leader, and a former recipient of NHPCO’s Heart of Hospice Award.

One of the best ways to exchange ideas and tips with your colleagues is through the NCHPP Clinical and Operations Management Section eGroup on NHPCO’s professional networking site, My.NHPCO. (It’s free for staff and volunteers of NHPCO provider-members.)

Each NCHPP Section has an eGroup on My.NHPCO (much like the former listserves, but better), plus an eLibrary where members post helpful information and resources to help one another.

If you’re not already a My.NHPCO user, visit the homepage and see “Getting Started” in the top right corner. For specific questions, contact the NHPCO Solutions Center at 800-646-6460 (Monday through Friday, 8:30 a.m. to 5:30 p.m., ET).

My.NHPCO: A Great Resource for Hospice Managers

References:

Covey, S; McChesney, C; Huling, J. (2012) The 4 Disciplines of Execution: Achieving Your Wildly Important Goals. New York: Simon and Schuster.

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HEALTHCARE CONSULTANTS

Adv

ertis

emen

t

The Benefits of Offering a Charitable Gift Annuity (CGA) to Your Donor

n No matter what happens to interest rates or the stock market, they or their beneficiary receive fixed payments for life.

n Donors make a gift with a minimum gift of $10,000 cash or other property.

n In most cases, CGAs provide significant tax savings.

Partner with the National Hospice FoundationYour Program Receives a Portion of the Remainder

n Avoid administrative and management costs, as well as financial risk.

n Eliminate the need to train staff and purchase expensive software.

Add CGAs to Your Giving Menu!

To learn more about partnering with NHF, please contact Heather Slack-Ratiu, 703-837-3155, or [email protected]

30 NewsLine

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NHPCO is proud to showcase the winning photography and social media video entries from the 2012 Creative Arts Contest…. A true testament to the talent and creativity of

NHPCO members all across the country.

C r e a t i v e A r t s C o n t e s t

NewsLine 31

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First Place:

SmittyMary Landberg,

Asante Hospice at Rogue Valley Medical Center, Medford, OR

Photography — Patient/Family Category

“Those who crossed Smitty’s path fell in love with him. He was genuinely happy and had a presence about him that was rare for someone with advanced dementia. On the day this photo was taken, he was feeling anxious, probably because he couldn’t wheel himself around the facility anymore. His family then arrived, surrounded him and laid their comforting hands over him. This spontaneous photograph captures what happens with simple, loving touch.” [More of Mary’s photos can be seen on her website.]

—Mary Landberg

32 NewsLine

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First Place:

SmittyMary Landberg,

Asante Hospice at Rogue Valley Medical Center, Medford, OR

Photography — Patient/Family Category

“Those who crossed Smitty’s path fell in love with him. He was genuinely happy and had a presence about him that was rare for someone with advanced dementia. On the day this photo was taken, he was feeling anxious, probably because he couldn’t wheel himself around the facility anymore. His family then arrived, surrounded him and laid their comforting hands over him. This spontaneous photograph captures what happens with simple, loving touch.” [More of Mary’s photos can be seen on her website.]

—Mary Landberg

Honorable Mention:

Hopeful HandsThom Sivo,

Hospice of the Western Reserve, Cleveland, OH

Second Place:

Sweet Kimberly and Caring Nurse AngelaOscar Pedraza, Nathan Adelson Hospice, Las Vegas, NV

Honorable Mention:

Jane withGreat-Grandfather’s Flag

Kenny King, Columbus Hospice of Alabama, Columbus, GA

Photography — Patient/Family Category

NewsLine 33

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Photography — Staff/Volunteer Category

First Place:

“Leaning on the Everlasting Arms”Les Wilkes,

Hospice Savannah, Inc., Savannah, GA

“Hospice Savannah offers a Family Photography program for patients who don’t have good quality family photographs (a surprising number do not). As volunteer photographers, we often spend time with the families in order to capture meaningful portraits. This family became very close to our music therapist, and requested that she join them for this photograph. They love to sing hymns, and here they were singing that great hymn by Elisha Hoffman.”

— Les Wilkes

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Honorable Mention:

Minnie CruzCraig Heartly,

Solari Hospice Care, Scottsdale, AZ

Second Place:

Hospice Volunteers Come in All Shapes and SizesCathy Coates,

Florida Hospital HospiceCare, Ormond Beach, FL

Photography — Staff/Volunteer Category

Honorable Mention:

Our Volunteers MakeOur Patients Happy… Even the

Ones With Wet NosesEbony Faber,

Suncoast Hospice, Clearwater, FL

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Photography — Nature/Abstract Category

First Place:

PartnersLaura Segelhorst,

Passages Hospice, Lisle, IL

“This photo was taken on the beach in Mexico. One of the handprints is mine, a hospice nurse who has touched many patients’ lives. The other handprint is my husband’s, who has worked hard to provide for our family, allowing me to dedicate my time to hospice. To me, this photograph represents two examples of diversity—in being American hands on Mexican soil and in the hand prints themselves…. Diversity is only valuable if we overcome it and work together….”

— Laura Segelhorst

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Photography — Nature/Abstract Category

Honorable Mention:

Celebration of Life,Live Butterfly Release

Oscar Pedraza,Nathan Adelson Hospice, Las Vegas, NV

Second Place:

Reflections GardenWanda Chiles,

Hospice of the Bluegrass, Cynthiana, KY

Honorable Mention:

VarietyJoelle Beebe,

Woodland Hospice Morey Bereavement Center,

Mt. Pleasant, MI

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Social Media Videos

First Place:

Diversity of

Heart of

HospiceHeart of Hospice, Lafayette, LA

Honorable Mention:

Circles of Care Volunteer Program

The Denver Hospice, Denver, CO

Second Place:

HomecomingHospice Hawaii, Honolulu, HI

“We’re from Louisiana...diversity is ingrained in us. We are descendants of people who fled here as a means of creating a new place where people of different backgrounds could exist together, peacefully. If you look around, this is still in practice today…. This is how the Heart of Hospice volunteer program is built: different people of different backgrounds, ethnicities, races, genders, political views…and different views of the world...but one very big important thing in common: volunteering for hospice….”

—Heart of Hospice

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NewsLine 39

NHPCO and WHV Partner, Hospice of Michigan, Pay It Forward

On October 28, Navy Vet, Vincent Garbesi, and his brother-in-law, Chris Quarles, a Vietnam Vet, were seated near first-base at Detroit’s Comerica Park as the Detroit Tigers and San Francisco Giants vied for the World Series title.

Sixty-nine year old Garbesi is a devoted Tigers fan and a patient of WHV Level Three Partner, Hospice of Michigan, but had never been to Comerica Park, let alone to a World Series game! But two tickets to this year’s World Series were part of an ad package that NHPCO purchased to help promote the We Honor Veterans program and the staff at Hospice of Michigan were quick to identify an appropriate patient who’d be able to attend—and enjoy it.

“We were thrilled,” Garbesi said, “and very grateful for this unexpected, once-in-a-lifetime experience.”

Member News and Notes

FHPC Celebrates 30 Years

This October, Florida Hospice & Palliative Care Association (FHPCA) celebrated its 30-year anniversary of dedicated service to hospice care in Florida.

Established as Florida Hospices, Inc. in 1982, FHPCA’s grassroots effort first began in 1979 with the formation of the Florida State Hospice Organization (FHSO).

The hospice pioneers that formed FSHO, including incoming Florida Senate President, Don Gaetz, coauthored the Florida Hospice Act of 1979—the first state law in the country to establish hospice and allow patients to be admitted into hospice care. In 1982, after completing its primary mission and purpose of helping to pass the hospice licensure law, it handed over its duties to successor association, FHPCA, to continue the work.

“FHPCA started off with no staff and with its financials in a shoebox,” said Mary Ellen Poe, the president of FHPCA and president/CEO of Hospice of Marion County. “Now we have a full staff, led by executive director, Paul Ledford, and multiple projects, committees, and initiatives happening every day. We have accomplished a lot these past 30 years.”

Ernesto Lopez Joins Hospice of the Comforter

Hospice of the Comforter, based in Altamonte Springs, FL, has named Ernesto Lopez, RN, BSN, MBA, as the organization’s new administrator. Lopez formerly served as assistant administrator at Florida Hospital Kissimmee for four-plus years, and has been with Florida Hospital for nearly seven years.

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New Compliance Tip Sheets

Tip of the Month

40 NewsLine

NHPCO’s Regulatory team has developed three new tip sheets—available to members free of charge—to assist them in understanding and complying with the CMS requirements in the following important areas:

Issuance of the ABN and NOMNC

This tip sheet provides guidance on when the issuance of the Advance Beneficiary Notice and the Notice of Medicare Non Coverage are mandatory.

The Revalidation Process

The revalidation initiative is mandated by the Affordable Care Act (Section 6401[a]). It requires that CMS verify all information on file for all existing Medicare providers to ensure they meet all standards associated with new screening criteria. This tip sheet provides information about the revalidation process and the steps for compliance.

The Hospice Election Statement

Auditors have focused recently on hospice provider compliance with the Notice of Election. This tip sheet provides the regulatory components that must be present in the election statement, including updated language that was effective in March of 2011.

These free tip sheets, as well as other helpful resources, are posted in the “Tools for Compliance” section of Regulatory Center on the NHPCO website. Bookmark the webpage for future reference.

Don Berwick

Dan Heath

Ellen Goodman

Where can hospice palliative care leaders engage with…

■ The former CMS Administrator and Founding CEO of the Institute for Healthcare Improvement, Don Berwick?

■ Fast Times columnist, best-selling author and Senior Fellow at Duke University, Dan Heath?

■ The nationally-known former Boston Globe Columnist and the Co-Founder and Director of the Conversation Project, Ellen Goodman?

April 25-27, 2013Gaylord National Resort and Convention CenterNational Harbor, Marylandwww.nhpco.org/MLC2013

Only one place… NHPCO’s 28th Management and Leadership Conference

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NewsLine 41

Don Berwick

Dan Heath

Ellen Goodman

Where can hospice palliative care leaders engage with…

■ The former CMS Administrator and Founding CEO of the Institute for Healthcare Improvement, Don Berwick?

■ Fast Times columnist, best-selling author and Senior Fellow at Duke University, Dan Heath?

■ The nationally-known former Boston Globe Columnist and the Co-Founder and Director of the Conversation Project, Ellen Goodman?

April 25-27, 2013Gaylord National Resort and Convention CenterNational Harbor, Marylandwww.nhpco.org/MLC2013

Only one place… NHPCO’s 28th Management and Leadership Conference

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Videos Worth Watching

NewsLine is a publication of the National Hospice and Palliative Care Organization

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All past issues of NewsLine are posted online: www.nhpco.org/newsline.

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A Social Media Winner!

On November 5th, NHPCO announced the winners of this year’s Creative Arts Contest, including the three winners in the Social Media Video category. Our first-place winner was Heart of Hospice in Lafayette, LA, which created the dynamic “Diversity of Heart of Hospice” video. Watch it now!

(Be sure to also check our Special Section in this issue, with all the winning entries!)