NAHC and NHPCO Share Plans to Merge
In late December, the National Association for Home Care and Hospice (NAHC) and National Hospice and Palliative Care Organization (NHPCO) shared publicly the creation of a board to guide the continuing and intentional efforts to create one combined organization. The board will serve as overseer of the transition to this new organization, with expectations to complete the merger in 2024.
The newly-named board of 20 persons was selected by both NAHC and NHPCO. “The Transition Board,” says the 12/21 media release of each organization, “includes equal representation from NAHC and NHPCO — directors with deep experience in home health, hospice, palliative care, personal care services, home care, and private duty. The board also includes business partners, representatives from state associations and at-large members. The board and officers will be ratified when the Definitive Agreements are signed in early 2024.”
Until the merger, the two organizations will operate their organizations as separate entitles. Then, if the merger is completed, they “will work on a combined strategy that will be put in place for 2025.” An article in Home Health Care News says that Bill Dombi will stay as NAHC’s president through 2024.
Dombi calls the timeline for the merger an aggressive one. He says, “‘“We have yet to exchange the data and have it analyzed on the due diligence side of things. Obviously, fiduciary obligations tell us we’ve got to do a deep dive here, and no one’s not cooperating in this — it’s just going to take some time.’” NAHC’s board chair Ken Albert says, “the next few months will consist of organizational structure meetings with a steering committee and a CEO search for the new association.” The article in Home Health Care News includes a timeline for the process, with hopes for July1 to be “Day 1 of Consolidated Operations.” Albert says, “‘We will absolutely identify the economic and financial framework that we need to work with in order to be able to balance association management with highly qualified staff to produce a value-based product for our members.’” Albert also wants to build reserves, saying that this is prudent, adding, “‘. . .We need to continue to reassure our members that business prudence and due diligence is being employed all along the way as we’re designing what this new organization will look like.’”
Dombi also reported to Home Health Care News that some pushback has been received. Most of this negative feedback, says Dombi, focuses on a fear that hospices will not get adequate attention. “Those are coming from people who don’t really understand that hospice is not a new area for us,’” says Dombi. “There have been decades of very successful work on the advocacy side for hospice. The education side of [the merger] should take care of some of the criticisms and some of the questions that have been raised.’”
NAHC’s board chair, Ken Albert said, “‘We have got to unify the sector of healthcare home under a one voice banner on the Hill and in the state capitol,” Albert said. “We’re looking towards the future. What are we going to need as an association for our members — five years and 10 years down the road? Let’s build that together now. . .’” (NAHC Newsroom, 12/21/2023, https://nahc.org/nahc-and-nhpco-announce-transition-board-of-directors; NHPCO News, 12/21/2023, https://www.nhpco.org/nahc-and-nhpco-announce-transition-board-of-directors/; Home Health Care News, 12/21/2023, https://www.nhpco.org/nahc-and-nhpco-announce-transition-board-of-directors/; https://homehealthcarenews.com/2023/12/nahc-nhpco-announce-transition-board-ahead-of-potential-merger/)
HOSPICE NOTES
An article in Time, “The Language of Hospice Can Help Us Get Better at Discussing Death,”shares about a study that observed language of hospice workers and offers feedback on an important quality about communications of hospice staff. Daniel Menchik, associate professor of sociology at University of Arizona, “studies the use of language in different fields of medicine. . .” Menchik spend eight months listening to hospice team meetings in a hospice care facility. As he listened to the verbs used by hospice providers, he noticed they used three different types of verbs. The first was verbs are predictive verbs that predict the future, such as “‘will’” and “‘going to.’” The second, imperative verbs, are those that include a call to action, such as “‘should.’” The third verbs, subjective “convey some sort of personal stance when talking about the future. “Think,” “feel,” “want,” and many other expressive phrases fall in this category.” Menchik believes that when patients and families first enter hospice, their ability to talk about death is limited. “. . Hospice workers help bridge that gap by minimizing their use of imperative verbs. In meetings he observed, imperative verbs made up just 17% of the verb phrases used by hospice professionals. That’s fairly uncommon in medicine.” (Time, 12/18)
In late December, Springfield, Oregon’s “PeaceHealth home and hospice care nurses represented by Oregon Nurses Association voted to authorize a strike, but one will not be called immediately.” Contract negotiations have been in progress for 10 months. Limited staff and nursing pay are the primary concerns. Federal mediation was scheduled to begin on January 5. (KEZI ABC; 12/29)
The Journal of Pain and Symptom Management, offers “Quality of Data on Profit Status Reported Care Compare.” Researchers Joan M. Teno, Emmanuell Belanger, and Gulmeena Kahn report that “For-profit hospice providers differ in both key processes of care and bereaved family member perceptions of the quality of care.” Fast-growing numbers of hospices, creation of “national for-profit chains, and acquisition of hospice by private equity firms,” say the researchers, “has raised concerns regarding the quality of care.” CMS responded to the question by, beginning in April 2023, publicly-available hospice ownership data being offered on Care Compare to better “help consumers make informed choices in hospice programs.” Here, hospices are listed by tax status and other categories. In the article, the author/researchers examine “the accuracy of the information.” (Journal of Pain and Symptom Management, 11/8/23, https://www.jpsmjournal.com/article/S0885-3924(23)00772-8/fulltext)
Affiliations and acquisitions trends among nonprofit hospice providers is the focus on article in Hospice News. Hospices that affiliate or buy another company must consider both the benefits and risks. The article includes feedback from several hospice leaders have engaged in these processes. (Hospice News, 1/5, https://hospicenews.com/2024/01/05/to-affiliate-or-acquire-trends-in-nonprofit-hospice-consolidation/)
Based on 2023 earning, an article in Hospice News says The Pennant Group and ADDUS HomeCare are in good positions to acquire, according to Mertz Taggart, an M&A advisory.
“. . .The actions of those large companies can have an impact on smaller organizations that are on the hunt for deals.” (Hospice News, 1/2, https://hospicenews.com/2024/01/02/the-public-hospice-companies-most-likely-to-acquire-in-2024/)
Two New York Healthcare organizations are collaborating in order to promote “value-based hospice and palliative care,” and to “establish a transitional care program to improve in-home care.” Bassett Healthcare Network is partnering with Helio care in this work. Leaders of the two organization say the work that they have already done together will strengthen the care offered to patients by this enlarged collaboration. The efforts “will create an electronically driven referral process,” and will “prioritize developing a transitional care program to provide in-home care for patients with serious illnesses, chronic diseases, and end-of-life needs.” (RevCycleIntelligence, 1/3, https://revcycleintelligence.com/news/ny-healthcare-orgs-collab-to-deliver-value-based-hospice-palliative-care)
PALLIATIVE CARE NOTE
“The outlook for palliative care growth is ‘strong’ and ‘substantial,’ according to Dr. Sean R. Morrison, the Ellen and Howard C. Katz Professor and chair of the Brookdale Department of Geriatrics and Palliative Medicine at Mount Sinai.” The diversity of providers is growing, driven in part by the growth of and “an involving reimbursement climate. Movement in value-based care is promoting the growth. With hospices and home health having “dominated the palliative care market, primary care providers have increasingly delved into the space.” (Hospice News, 1/8, https://hospicenews.com/2024/01/08/provider-partnerships-driving-palliative-care-growth/)
END-OF-LIFE NOTES
“Can AI Help you Die?” appears in Bloomberg Business. Physicians at New Jersey’s Hackensack Meridian Health created “Serious Illness Care Connect.” This is a software tool designed to calculate if a patient might die in the next six months. It was created by an “in-house team of data scientists and hospice providers,” is built on patient data. If the AI scores a patient at 70% or higher on chance of death, an evaluation for hospice care is indicated. Between 30-60% calls for a palliative care conversation.” (Bloomberg Business, 12/18/2023, https://www.bloomberg.com/news/articles/2023-12-18/new-jersey-doctors-test-using-ai-for-hospice-care-decisions)
~ New York Times shares an opinion guest essay, “I Promised My Sister I Would Write About How She Chose to Die.” The author shares her sister’s decision to use Medical Aid in Dying (MAID), the process for the family, and the story of her sister’s last days. She shares about MAID from several perspectives, and tells of the difficulties her sister faced, even though she lived in NJ that has a MAID law. New York Times, 12/28, https://www.nytimes.com/2023/12/28/opinion/medical-aid-death-choice.html)
~ “Prepping for the Great Gig in the Sky” appears in BOSS. The article focuses on the huge numbers of aging seniors, their needs in care, and the fiscal costs of that care. End-of-life care costs are high, and longer life spans make the overall costs even higher. Sheer numbers of the growing aging population creates another challenge. The article encourages planning for care well ahead of when the care is needed. (BOSS, 1/3, https://thebossmagazine.com/end-of-life-care/)
~ Lynda Bluestein, Connecticut resident, ended her life in Vermont by using prescribed medication. Compassion and Choices filed a lawsuit against Vermont in 2022, saying “Vermont’s residency requirement in its so-called patient choice and control at end-of-life law violated the U.S. Constitution’s commerce, equal protection, and privileges and immunities clauses.” The state settled the lawsuit, “becoming the first state in the country to change its law to allow terminally ill people from out of state to take advantage of it to end their lives.”
~ “How to ensure your passwords don’t die with you” appears on Fox News and encourages people to include digital records in their end-of-life planning. The article also explores password managers. (Fox News, 1/7, https://www.foxnews.com/tech/how-to-ensure-your-passwords-dont-die-with-you)
OTHER NOTES
~ Milwaukee Journal Sentinel says that Wisconsin Republicans will once again bring a medical marijuana bill to the Assembly in January. Legislators are working to find a bill that can pass. Democrats introduced a bill that, while not legalizing marijuana, would reduce the fine for people possessing up to 14 grams. The article also notes that Illinois collected taxes of over $36 million from Wisconsinites. A Marquette Law School Poll found 64% of Wisconsinites support legal marijuana and 83% support medical use marijuana. (Milwaukee Journal Sentinel, 12/21/2023, https://www.jsonline.com/story/news/politics/2023/12/21/wisconsin-medical-marijuana-legalization-bill-to-return-in-january-2024/71871796007/)
~ If some proposed rules are finalized, it will become easier for controlled substances to be prescribed via telemedicine. DEA “is expected to develop a ‘special registry’” that would allow this to happen. In response to LeadingAge and other key leaders, DEA reconsidered, offered the pandemic allowance of such prescriptions to continue through December 2024, and may now “make such flexibilities more permanent.” On the same day, the American Colleges of Physicians issued a statement of concern about his, saying, “These direct-to-consumer services have the potential to leave patients confused and misinformed about medications.” Both articles are online at the links below. (McKnight’s Home Care, 1/5, https://www.mcknightshomecare.com/upcoming-e-prescribing-regs-could-give-relief-to-hospice-palliative-care-providers-advocates-say/; American College of Physicians, 1/5, https://www.acponline.org/acp-newsroom/internal-medicine-physicians-concerned-by-direct-to-consumer-pharmaceutical-sales-of-prescription)
~ Modern Healthcare offers “Here are the new state healthcare laws taking effect in 2024.”
https://www.modernhealthcare.com/government/healthcare-laws-2024-california-texas-illinois
~ Becker’s Hospital Review offers “12 healthcare trends and issues we are following for 2024. Some concerns are noted here and all are online at the article linked below. We are facing a physician shortage and expect that shortage to grow by 2034 to between 37,800 to 124,000 primary care physicians and specialists. Medicare and Medicaid payments are now larger than commercial payer sources. Medicare Advantage now covers more than half of Medicare beneficiaries. And MA providers were overpaid in fiscal year 2023 by an estimated $16.6 billion. Mental illness is growing, with an estimated one in five prevalence. At the same time, there is a mental health workforce shortage. Private equity in healthcare is drawing attention of legislative scrutiny, but political issues interfere with finding best solutions. (Becker’s Hospital Review, ½,
~ A study reported in JAMA found people over 50 years who own pets have a slower rate “of decline in verbal memory and verbal fluency” that is not experienced for those living alone. Researchers call for further study. (JAMA Network, 12/26/2023, https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2813138)
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Hospice Analytics is the national sponsor of Hospice News Network for 2024. Hospice Analytics is an information-sharing research organization whose mission is to improve hospice utilization and access to quality end-of- life care. For additional information, please call Dr. Cordt Kassner, CEO, at 719-209-1237 or see www.HospiceAnalytics.com.
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