A 40-year veteran of the hospice community, Judi Lund Person, is the vice president for regulatory and compliance for the National Hospice and Palliative Care Organization. She actively works with the U.S. Centers for Medicare & Medicaid Services (CMS) to ensure that hospice has a seat at the table when policy and payment decisions are being made, as well as working with other federal agencies and members of Congress.
Person provides regular guidance to providers and state hospice organizations on the complex web of regulatory and compliance requirements to help organizations understand and comply with those rules. Prior to joining NHPCO, she served for 22 years as the president and CEO of The Carolinas Center for Hospice and End of Life Care and was an early advocate for the passage of the Medicare Hospice Benefit in Congress.
Hospice News caught up with Person to discuss how hospice has changed during her tenure in the space and what regulatory shifts providers can expect in the new year and presidential administration.
What first led you to the hospice field?
I met a man on an airplane. I am a social worker by training and was working in Raleigh, N.C., in volunteer programs for the state government. I was flying to Chicago for meetings and I sat down in the middle seat. The guy who was at the window had his papers spread out all over the place. Midway through the flight we started talking, and he said he was going to a meeting of the National Hospice Organization Standards Committee.
He was responsible for bringing the job descriptions of hospice team members to this meeting, and he said he didn’t understand the role of the volunteer manager. We started this long conversation, and I later provided him with some information about volunteer management.
We had further discussions, and it turns out that he was the president of the board for Hospice of North Carolina. I ended up joining that board. This was before the Medicare Hospice Benefit. When the executive director of Hospice of North Carolina retired, they asked me to take the job.
In my first years I was traveling around the state helping hospices get started. When I came, there were five hospices in North Carolina. When I left, we had merged with a South Carolina organization, and there were 125 hospices in the two states. Also a lot of my early work was focused on the passage of the Medicare Hospice Benefit and how to design that benefit.
I came to NHPCO in July of 2002 to work on state and federal regulatory issues.
What are some of the ways that you’ve seen hospice care evolve during the course of your career?
In the first days of hospice there was no Medicare payment. The hospices in North Carolina that I was most familiar with had one employee and everybody else was a volunteer, including the doctors and nurses. Getting hospice payment through Medicare was a big deal for a lot of the early community-based providers.
I think Medicare has changed us, in some ways for the better. We can see more patients now that we are not spending three-quarters of our time doing fundraisers and looking for grant dollars to support the care that we provide. The huge number of hospice providers out there now certainly represents change. I think the market will settle how many providers are enough in a given community. But certainly that’s a concern. It can be hard to really figure out who the high quality providers are.
At a recent [Medicare Payment Advisory Commission] meeting I attended it was reported that 51% of people who died on Medicare had received hospice care. That more than half of the people who die in this country who are on Medicare used hospice is astounding and a fantastic tribute to all the work that we’re doing.
The original Medicare Hospice Benefit was completely predicated on a cancer diagnosis. We originally thought that the vast majority of our patients would be cancer patients. Now less than 30% of hospice patients have cancer, and the other diseases are taking 70% of our patient population. No matter what disease you have, hospice will be there. That’s an amazing legacy for a benefit that is now almost 40-years-old.
What do you see as the next steps in the evolution of hospice?
We’re already starting to see consolidation. We’re thinking about a broader array of services and a broader timeframe than just the last six months of life. Hospices are already providing a full range of care continuous from diagnosis through the disease process to the end of life, so patients have support no matter where they are in the course of their illness.
Expanding into community-based palliative care much more fully is a big piece of this, looking at ways that we can logically and thoughtfully reform the hospice benefit. Some new components can be added to it, and some of the factors that were based solely on the cancer care model can be sunsetted. I think all of those things are certainly a part of where we’re headed.
What aspects of the hospice benefit Do you think should be sunsetted?
We want to think about that six-month terminal prognosis requirement. Should we come up with something besides six months? I don’t think we really know what the marker should be, but that six months is quite limiting.
On the other side of that, if we’re thinking about a full care continuum, then community-based palliative care will be more likely to be the entry point than patients going into hospice three weeks before death.
How do you expect the incoming Biden administration to impact hospice and palliative care?
A lot of the regulatory work is done at the career staff level, so the folks who have been there for a while with whom we’ve developed great relationships over the years. We will continue those relationships in the new year and in the new administration I’ve certainly had a few people tell me that additional [regulatory] scrutiny is on the way. That will be a focus for the new administration in general, not just for hospices. That’s something that we’re preparing for.
I think also some opportunities to think about new ways to do business and some new models with more options for building that care continuum and making sure that we’ve got all the components in place. I am very hopeful that some of the work that we have already started can continue.
Community-based palliative care might be a model that could be considered in the future, as well as what might happen with the great success of the Medicare Care Choices Model.
We have to be laser-focused on reporting and making sure that we are watching for the new scrutiny that might come down. We have to focus on the kind of medical review we will be looking at and how payment could change.