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HIAWATHA, Iowa — LeAnn Thrapp didn’t have to apply too much pressure when U.S. Rep. Rod Blum visited the Dennis & Donna Oldorf Hospice House of Mercy in Hiawatha earlier this week.

The tour she led Blum on was part of the lobbying efforts by hospices nationwide to build support for changes they would like in reimbursement and the utilization of health care professionals.

At times, it was hard to tell who was lobbying whom.

“This is fantastic. You’re doing God’s work,” he told staff Monday at the hospice that is part of Mercy Medical Center network.

Blum talked about his mother, Celeste, receiving hospice care in her Dubuque home before she died in March 2014.

“I became a real believer” in hospice care, Blum said. “They did a marvelous job, and I have such respect for what they do.”

Most people, he said, will be touched by hospice care at some point in their lives.

“We’re all going to get to go there so the more we talk about it, normalize it, that help makes end-of-life care OK,” Thrapp said. “Death always is hard to talk about. We all want to know that we did all we possibly could. That’s where we come in to say, ‘You did.’”

Thrapp told Blum hospices will benefit from a change Congress made in Medicare reimbursement beginning in 2016 to pay a higher rate for the first 60 days of hospice care — the average stay is seven days — because of the intensive work involved when care begins. The rate drops about $20 a day after that.

Blum was supportive of another legislative initiative sought by hospices — Medicare reimbursement for time physicians spend discussing end-of-life issues with patients and their families.

Physicians are more likely to discuss issues such as who will make decisions for patients unable to make their own and whether to have CPR or not if they are reimbursed for their time rather than leave them to nurses or others, Thrapp said.

“Most families want to hear it from their primary care physician,” she said.

Blum, a first-term Republican from Dubuque, said that “as a career business guy, I always say we have to think outside of the box on health care.”

One of those “outside of the box” ideas is to allow nurse practitioners and physicians assistants to play a larger role in hospice services. Because they often are more readily available than physicians and reimbursed at a lower rate than physicians, their utilization a “win-win for hospices and the federal budget,” Blum said.

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