Date: 09/24/2009

Findings and Recommendations


Votes: View--> Action Taken:

09:50 AM

The committee took a brief recess.

09:58 AM -- Findings and Recommendations

The committee reconvened. Dr. Cordt Kassner introduced Bev Sloan, Denver Hospice, and Christy Whitney, Hospice and Palliative Care of Western Colorado. He stated that the panel will provide a wrap-up and its recommendations to the committee. Ms. Whitney spoke to the differences between the various hospices across the state. She stated that there is not one specific cultural perspective to hospice care; it is dependent on the community and environment. The committee discussed the cost saving aspect of hospice care.

10:11 AM

Dr. Kassner provided a handout to the committee which describes suggested legislation and committee recommendations (Attachment C). He spoke to the first recommendation and stated that there are four bullet points, but the overall goal of the first recommendation is to increase efficiencies for hospice. He stated that the first recommendation would allow Medicaid to reimburse a long-term care hospice for a patient's room and board directly rather than paying a hospice facility which then reimburses the long-term facility. He stated this recommendation would eliminate the 'pass through' and reduce administrative burden. The committee and the panel discussed the recommendation.

Attachment C.pdf

Dr. Kassner stated that the second part of the first recommendation is to mandate long-term care to use selected medical diagnosis service (MDS) measures to trigger the offer of a hospice or palliative care consult. He stated that this will increase efficiencies. Ms. Sloan stated there are wide varieties between nursing homes and this recommendation goes to making this process more consistent. Senator Tochtrop stated that she thinks this recommendation can be done through rule making. She stated she is concerned that it could lead to micro-managing long-term care facilities and could have unintended consequences.

Dr. Kassner spoke to third part of the first recommendation which would allow Medicaid to reimburse hospice in-patient facilities for room and board costs when they provide residential level of care. Ms. Whitney stated that this recommendation would not impact a large number of people, maybe five or six individuals. Ms. Whitney stated that the Department of Health Care Policy and Financing is receptive to this recommendation.

Dr. Kassner spoke to the final part of the first recommendation which would allow Medicaid to reimburse advanced practice nurses for visits made outside of a clinic setting.

10:29 AM

Dr. Kassner stated that the second recommendation would allow registered nurses to pronounce death. The was discussion among the committee members regarding where advance practice nurses (APNs) stand regarding this recommendation. Representative Riesberg stated that one of the concerns is that there are not enough physicians in rural communities to sign death certificates. He stated that numbers have been provided to him that show that there are more physicians than APNs in rural communities. Representative Roberts stated that there may be more physicians than APNs, but it is also a matter of whether the physician wants to sign death certificates. Ms. Sloan stated that APNs are already pronouncing death when they call a physician and say, 'the patient does not have any vital signs, he or she is deceased.' She stated that many physicians do not appreciate being called in the middle of the night, even though that is what the law requires.

10:42 AM

Dr. Kassner spoke to recommendation number three which would clarify and update the living will statue.

10:43 AM

Dr. Kassner described recommendation number four which includes three parts. He described the first part which is to implement the Colorado Advance Directive Consortium recommendations regarding the Medical Orders for Scope of Treatment (MOST) form. The second topic includes language edits to the Colorado Department of Public Health and Environment CPR directive and the last topic comes from the Colorado Medical Society and goes to Ms. Hershey's testimony regarding edits to House Bill 08-1061 to revert to the original language stating that only physicians may certify terminal illness rather than physicians or APNs.

10:48 AM

Dr. Kassner highlighted several recommendations from the panel that would not require statutory changes, but could be regulatory changes. He stated a lot of the suggestions have to do with education and outreach. There was discussion between the panel and the committee regarding the timing of implementing the recommendations.