As the Affordable Care Act shapes the future of patient care in the United States…

As the Affordable Care Act shapes the future of patient care in the United States, the issue of healthcare’s “revolving door,” or avoidable hospital readmissions, continues to take a front seat in the national conversation. Rehospitalization among Medicare beneficiaries has become a top priority for both policymakers and the Centers for Medicare and Medicaid Services (CMS) as hospitals feel added pressure to help patients remain at home.

Front Range Hospice is working hard at maintaining current relationships and developing strong relationships with the hospitals in our service territory. Front Range Hospice is the first hospice along the northern front range to track return to hospital rates along with other clinical data measures on patients receiving care through Front Range Hospice. Why do we track data you ask?
Nearly one in five Medicare beneficiaries is readmitted to the hospital within 30 days of release. As of this post Front Range Hospice has a zero percent return to hospital rate. Tracking this data allowed us to show our hospital partners how hard we work to support our patients and our hospital partners.

The CMS has taken on several initiatives to reduce readmissions – an important measure of patient care quality – from reporting hospital readmission rates and changing payment policies, to implementing shared savings programs in efforts to increase care coordination among post-acute care providers.

The biggest change, as part of the healthcare overhaul: Medicare began penalizing hospitals with high readmission rates for heart failure, heart attack, and pneumonia cases. In 2012 more than 2,000 hospitals received a reduction of up to one percent on their Medicare reimbursements. This penalty will increase to a maximum of two percent this year 2014, and three percent in 2015.
Because Front Range Hospice has developed chronic disease programs our staff is trained on how to manage chronic diseases like CHF and COPD in the home. Front Range Hospice nurses are able to better support the patient and family at home, reducing or eliminating the return to the hospital. Resulting in better family satisfaction and no penalties issued to the hospital.

Why Are Patients Returning to The Hospital?
There are some return trips to the hospital that are unavoidable – due to complications, new and unrelated problems, or anticipated steps of certain treatment plans. Some patients are also readmitted because they live in a region where hospitals are used more frequently as a place of care for illnesses.

Regardless of where patients reside, education and support are key factors in preventing readmissions to hospitals. We work hard to provide education to our patients and families with every interaction we have with them. The more education, the more comfortable the patient and family will feel, resulting in decreased or eliminating the trip to the ED or calling 911.

The Role of Hospice
Front Range Hospice is a leader in improving coordination of care between care settings and reducing avoidable hospital readmissions. Increasingly, hospitals are forming collaborative partnerships with hospice providers like Front Range Hospice, nursing homes and home care agencies to combat avoidable readmissions.

Front Range Hospice works closely with the hospitals, patients and families to identify care preferences, manage symptoms, and address clinical, emotional and spiritual needs through a team-oriented, interdisciplinary approach. This type of care allows patients to pick up the phone in a time of crisis and receive emergency medications at home, or a facility, without returning to the hospital.

Integrating hospice care services early in the hospital stay and making timely and appropriate hospice referrals can not only improve patient experiences, but address some of the most important issues faced by hospitals today: quality improvement, overcrowding in the ICU, increasing coordination of care, preventing complications, reducing costs – and ultimately, reducing return trips to the hospital in a patient’s final stages of life when comfort matters most.

-Victor Montour

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Honoring Veterans

As we celebrate the 4th of July Front Range Hospice asks that you pause to recognize the sacrifice from the millions of veterans in our Armed Forces. Since the Declaration of Independence was signed more than 200 years ago on July 4, 1776, our country has seen multiple wars – and called upon its sons, daughters, brothers, sisters, mothers and fathers to serve many times.

As our veterans age, they sometimes require special assistance beyond the typical senior citizen. Veterans may have physical wounds from battle injuries, or psychological wounds from being part of a war.

Even without service-specific wounds, veterans face the same diseases that we all do. World War II veterans are now all over 70, and many have cancer, dementia, chronic heart failure and other chronic or end of life diseases.


Like the rest of us, veterans need hospice care to guide them and their family through the end-of-life journey. These men and women deserve the best care available, and we are honored to serve them in their time of need.


It is never too late to honor and give a Veteran a hero’s welcome home. Front Range Hospice staff work hard to provide the last opportunity for Veterans to feel that their service was not in vain, and that they are appreciated. We do this with simple acts of gratitude at the end-of-life to make up for a lack of appreciation or recognition during the Veteran’s lifetime, especially for those Veterans who were never welcomed home or thanked for their service. Front Range Hospice will always, honor and recognize the Veterans we serve by providing;


Veterans with an opportunity to tell their stories.
Respecting Veterans’ service, their feelings, and any suggestions they might offer.
Thanking Veterans for their service to our country.
Providing a Veteran to Veteran volunteer program.
Showing our appreciation to the families of Veterans.
Always being sincere, caring, compassionate and ready and able to listen to what a Veteran or his or her family member has to share about the situation they are dealing with.
Being supportive and non-judgmental of our Veterans and always validating their feelings and concerns.
Being honest, sincere, caring and respectful.
Accept, without judgment, the Veteran as he/she is.
Being patient and listening.
Offering spiritual support for Veterans, family and friends.

Front Range Hospices asks that this 4th of July, stop and say THANK YOU to all of the service men and women who have made and continue to make the 4th of July possible. Without their sacrifice we wouldn’t be able to enjoy a day filled with family and friends or an evening filled with awesome fireworks.


Victor Montour
Hospice Liaison
Front Range Hospice
Providing Legendary End of Life Care
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Qualifying for Hospice: It used to be so easy, Or, The death of General Debility and Adult Failure to Thrive

Qualifying for Hospice: It used to be so easy,


The death of General Debility and Adult Failure to Thrive


In 2002 General Debility accounted for 6% of all Hospice claims and Adult Failure to Thrive was 3%. In 2012 there were a lot more hospices and General Debility accounted for 12% of all claims and was the number 1 code used on all hospice claims and Adult Failure to Thrive accounted for 7%. Why were there a lot more hospices? The American public is becoming more sophisticated in its choices for health care. They turn to the internet and look up diseases and their prognosis. They want to have more control over the end of their life and the Baby Boomers are entering retirement and caring for their parents and themselves.

Center for Medicare and Medicaid (CMS) thoughts

General Debility and Adult Failure to Thrive are: “non-specific, ill-defined diagnosis”

Since 2008 hospice has been required to do a comprehensive, individualized assessment and plan of care and if a non-specific, ill-defined diagnosis is used as primary this cannot be done (according to CMS). CMS says “these diagnoses are incongruous to the comprehensive nature of the hospice assessment”. They can be used as secondary or related diagnoses but not as primary diagnosis.

What all this means at Front Range Hospice

The Administrator and the DON are rapidly educating themselves on Coding for Hospice. All patients that were coded with a primary diagnosis of general debility or adult failure to thrive we have done the research and changed the primary diagnosis. Underlying the General Debility or the Adult Failure to Thrive is a primary disease that is creating this condition. We have done the research, found this disease and with the assistance of our Medical Director, we have changed the primary diagnosis.

Going forward, we will do the research and find a primary diagnosis that is not General Debility or Adult Failure to Thrive. It is important to Front Range Hospice that patients receive the hospice care that they are entitled to. This means that we must request more records and do more digging some times before our Medical Director is comfortable certifying what the terminal illness is.

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Happy CNA week!!!!

CNA Week is June 13 – June 20. Most people outside of healthcare have very little respect for CNA’s. When in fact, CNA’s are an intricate part of the nursing team and deserve the upmost respect.

The CNA provides a lot of the bedside care a patient may need. Assisting with activities of daily living like, brushing a patients teeth, giving bed baths, assisting patients with eating and many other tasks as directed by the RN or LPN.

Because of the amount of time a CNA spends with a patient they hear and observe the smallest changes in a patients condition. These changes are reported to the RN or LPN who facilitate obtaining the necessary treatment. CNA’s are the eyes and ears of the nurse when the nurse is not with the patient.

The CNA builds one of the strongest bonds with a patient. They learn the likes and dislike each patient has. They know just how to fold down the bed, fluff a patients pillow and if time allows they give a fabulous back rub to help their patients relax.

So the next time you see a CNA remember to thank them for caring about their patients. Thank them for bringing love and joy into the hearts of everyone they care for.

All of us at Front Range Hospice send a great big thank you to our CNA’s. We are fortunate to have each and every one of you on our team.

Happy CNA week!!!!

Victor Montour
Hospice Liaison
Front Range Hospice

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Hospice and Medicare D

Hospice and Medicare D

In 2003 Medicare developed an outpatient prescription benefit that is commonly referred to Medicare D. This has been beneficial to Medicare beneficiaries as it assists them in the cost of their maintenance prescription medications and any acute medications that they may need.  This program went into effect in Jan. of 2006.

Hospice is a managed care program covered under Medicare A. When an individual chooses hospice, the hospice becomes responsible for the cost of all medications related to their terminal diagnosis and related conditions that are designed for comfort and symptom control and all other medications related to symptom control as recommended by the hospice pharmacist and the hospice medical director.

The Office of Inspector General (OIG) published a report in June 2012 entitled “Medicare Could Be Paying Twice for Prescription Drugs for Beneficiaries in Hospice”. This is definitely a provocative title.  As you read the report it becomes evident that the OIG believes that there are certain categories of drugs that hospice should always pay for and should not be billed to Part D. These are: analgesics, Antinauseants, laxatives, and antianxiety drugs. Additionally they looked closely at two terminal diseases, COPD and ALS, and felt that all drugs related to these diseases should be covered by hospice.

What I have found in working with people is nothing is black and white. The response of Front Range Hospice to this entire issue has been very thoughtful and extremely aggressive and we believe that we are paying for every pill that we should be paying for. We are contracted with a Pharmacy Benefit Management Company that specializes in hospice and provides us an evidence based medicine approach to our drug formulary. Our formulary is a starting point. We do go outside of the formulary when we have documentation that a patient has tried what is on the formulary and has either had a negative reaction or poor results.

We will not be paying for all medications prescribed for pain or for the terminal illness if there is evidence that it does not work. For instance, if a 75 pound female whose healthy adult height was 5’7” comes on service with end stage dementia and she is bed bound, no longer continent, no longer speaks, and 100% dependent for all activities of daily living we will not be paying for a fentanyl patch, Namenda, or Aricept if ordered by her primary care physician.  Evidence based medicine tells us that a fentanyl patch needs fatty tissue to work and Namenda and Aricept are for early to mid-stages of dementia.  If the family choses to keep her on these drugs, they should be paying privately and not billing Medicare D. Hospice has no control over what the family does and all we can do is educate.

Front Range Hospice has reviewed all of its medication profiles (sheets), and primary and related diagnosis with our hospice pharmacy and our Medical Director. For those medications that we do not feel are hospice pay, we have sent in the proper form to the Medicare D provider for each of our patients. We have been appalled by the lack of response of some of the Medicare D providers. It is impossible to reach a human being and now the patient or family must make the decision to either go off the medicine or pay privately and fight the insurance company. In the meantime, the Medicare D provider continues to collect the premium.

Personally, I do anticipate a fix for this is coming. I still have faith in our federal government. We can all speculate what that will look like but at the very least the Medicare D provider will be required to respond within a short period of time and a clear appeal process will be laid out. I personally will do everything within my power to advocate that the subscriber not be held up in the pharmacy. I am only one voice. I will keep you informed.

-Pam Ware

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Remembering Those Who Served

Remembering Those Who Served

Many people consider Memorial Day to be the unofficial start of the season. This year, we celebrate the holiday on May 26. Many families will heat up the grill, head to the mountains or take in a big blockbuster movie. But Memorial Day has the word “memorial” in it for a reason.

The holiday was created to honor the many American men and women who died in military service. This focus on those who made the ultimate sacrifice sets it apart from Veterans’ Day, which honors all military veterans, living and dead.

It is customary to mark Memorial Day by visiting graveyards and war monuments. One of the biggest Memorial Day traditions is for the President or Vice President to give a speech and lay a wreath on soldiers’ graves in the largest national cemetery, Arlington National Cemetery, in Virginia. Here are some ways you can honor the men and women who serve our country:

- Put flags or flowers on the graves of men and women who served in wars.

- Fly the U.S. flag at half-staff until noon.

- Visit monuments dedicated to soldiers, sailors and marines.

- Participate in a National Moment of Remembrance at 3 p.m. local time.

- March in a parade.

Front Range Hospice and all its employees send our thanks and gratitude to the families of our fallen soldiers.

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National Nursing Home Week- Thank you

In honor of National Nursing Home Week, we would like to take a moment to honor and thank all of our nursing home partners for the immeasurable love and care they provide to their residents and our patients who live in their nursing communities.

As the nation’s population ages, nursing homes have become a significant partner in providing care at the end of life. Hospice services can significantly improve end-of-life care, so a good hospice-nursing home relationship is a crucial element in delivering such care. Front Range Hospice has strong relationships with nursing homes throughout our service territory as an additional option for patients and families to choose from.

The benefits of hospices in nursing homes are significant. Nursing homes receive the hospices expertise in pain and symptom management, psychological and spiritual support to the terminally ill, as well as supporting the patient’s family, access to enhanced patient benefits such as pharmaceuticals, bereavement support, and access to training resources. Hospices gain access to alternative bed arrangements for patient care outside the home, round-the-clock support and supervision, and dietary services.

If you or your family have questions or would like more information about how Front Range Hospice and Nursing Homes work together call 303-957-3101.

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