Fwd: This Week's Hospice News Network #PFD

[John Gear]

Subject: This Week's Hospice News Network

Date: October 29, 2013 10:22:30 AM PDT

To: John Gear <Jo...@JohnGearLaw.com>

Reply-To: Oregon Hospice Association <reply-768f9172e1...@u.cts.vresp.com>

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	October 29, 2013 Volume 17, Number 40 HOSPICE NEWS NETWORK what the media said about end of life care this week a service of the Oregon Hospice Association CURRENT EFFORTS DEMONSTRATE TENSION BETWEEN PREVENTION AND CURE OF AGING AND CHRONIC ILLNESS “Can Google solve DEATH?” exclaims the cover of a recent issue of Time magazine. The tech giant, used by billions on a daily basis to search the Internet, is beginning to invest in a far more ambitious venture - extending the human life span. This September, Google announced the formation of Calico, “a new company that will focus on health and well-being, in particular the challenge of aging and associated diseases.” The new venture will be headed up by Arthur D. Levinson, Chairman of Apple and Genetech, who will serve as CEO and a founding investor of the firm. At the same time, The New England Journal of Medicine and Harvard Business Review are joining forces to undertake “a novel collaborative publishing initiative” that will focus on “how to achieve a high-value health care system.” Ultimately, this initiative will represent a partnership between health care practitioners and the wider business world. The NEJM announcement explains, “The health care community and the business community today share a fundamental interest in finding ways to achieve higher value in health care.” “The ultimate objective for both communities is to keep people healthy, prevent chronic illnesses that consume a large fraction of our health care dollars, use medical interventions appropriately and only when needed, and create an economically sustainable approach to the delivery of health care.” NEJM emphasizes that while innovation and the development of new treatments is important, “we also recognize that, whenever possible, prevention of disease before it is established is the better solution.” In light of this emerging push to “cure aging,” Leslie Kernisan, writing for KevinMD, expresses her discomfort with an ethos that focuses solely on prevention and potentially underserves those who are presently struggling with the effects of chronic disease. “It’s not that I’m again prevention,” she writes, “But when we perpetually focus on cures and prevention, where does that leave those of us... who are struggling to manage multiple chronic diseases and age-related difficulties?” Kernisan suggests that we keep our focus on “the most urgent health policy problem of the next 10-20 years... how to provide compassionate and effective healthcare to the Medicare population, at a cost we can sustain.” While prevention plays a role in these efforts, Kernisan cautions against lending too much of our attention to pie-in-the-sky cures for aging, when the reality of chronic disease is being faced by millions of Americans right now. (KevinMD, 10/17, www.kevinmd.com/blog/2013/10/innovations-caring-curing.html; Google, 9/18, googlepress.blogspot.com/2013/09/calico-announcement.html; The New England Journal of Medicine, 9/19, www.nejm.org/doi/full/10.1056/NEJMe1310884; TIME, 9/18, business.time.com/2013/09/18/why-googles-new-venture-is-called-calico/) NH ONCOLOGIST DECIDES TO FOCUS ON PALLIATIVE MEDICINE This summer, Dr. Robert Friedlander ended his 30-year career as with the New Hampshire Oncology and Hematology in order to retrain in a new specialty, palliative care. For the next year, he will be at Memorial Sloan-Kettering Cancer Center in New York City, undertaking a fellowship with peers who are half his age. Yet, at age 57, Friedlander feels like he is merely continuing on the same trajectory that he has been on throughout his career as a physician. “I feel like I’ve always been a palliative care doctor. What was always important to me was what I called the human side of medicine,” he explains.  Friedlander might have made the switch earlier, except that his new specialty has only recently come into existence. Hospice and Palliative Medicine was approved as a subspeciality by the American Board of Medical Specialties in 2006, with the first board-recognized exam administered two years later. While all physicians provide palliative care in some measure, Friedlander is looking forward to making it his primary focus. In his previous line of work, Friedlander felt unable to give the kind of care his patients needed. He experienced “a growing dissatisfaction with his own ability, within the confines of oncology, to do that work as well as he thought it needed to be done.” For example, a typical follow-up visit with a patient he had known for years might last only 15 minutes. After spending most of the time checking out their physical stats and answering questions about symptoms, “you’d have two or three minutes left to ask them, are they sad? Are they anxious? Are they feeling overwhelmed? What kind of thoughts are they having about the future?” Fortunately for Dr. Friedlander and his patients, the number of palliative care programs is rising dramatically. Between 2000 and 2008, “the number of palliative care programs in US hospitals with 50 or more beds increased from 658 (24.5 %) to 1,486 (58.5%).” Friedlander is convinced that this meteoric growth is due to the fact that palliative medicine results in better patient care, as evidenced by “a landmark study by researchers at Massachusetts General Hospital in 2010.” For Friedlander, the switch to palliative medicine is a no-brainer. “In just three short months, I really feel that I am a better doctor now, which is remarkable to me, and really exciting.” (The Concord Monitor, 10/20, www.concordmonitor.com/news/work/business/8879413-95/robert-friedlander-local-oncologist-makes-mid-career-switch-to-palliative-care) HOSPICE NOTES One recent article asserts that interest in hospice is rising in Massachusetts following “Death With Dignity” campaign. The narrow defeat of legalized physician-assisted suicide in that state “has caused a shift in people’s perceptions of hospice, and many religious groups now promote hospice as a preferred choice over physician-assisted suicide.” (Telegram, 10/24, www.telegram.com/article/20131024/NEWS/310249600/1116) What psychological impact does hospice care have on caregivers who have lost a spouse with Alzheimer’s disease? A report published in The Journal of Palliative Medicine finds, “Data suggest that hospice enrollment may ameliorate the detrimental psychological effects” for these caregivers. (The Journal of Palliative Medicine, online ahead of print 10/5, online.liebertpub.com/doi/abs/10.1089/jpm.2013.0130) According to a recent study, “Managed care plans caring for Medicare beneficiaries may be better positioned to promote recommend services and discourage burdensome procedures with little clinical value at the end of life.” Specifically, the report concludes, “Relative to comparable [traditional Medicare] decedents in the same local areas, [Medicare Advantage health maintenance organizations] decedents more frequently enrolled in hospice and used fewer inpatient and emergency department services, demonstrating that [Medicare Advantage] plans provide less end-of-life care in hospital settings.” (PubMed, Med Care 2013 Oct;51(10):931-7, www.ncbi.nlm.nih.gov/pubmed/23969590) The Des Moines Register reported in April 2011 that Iowa hospice organizations are inspected only once every 20 years. Governor Terry Branstad (R-Iowa) “was unaware that Iowa is inspecting hospice-care facilities about once every 20 years, but said there’s no need to hire inspectors or take any action that might drive up costs for private health care companies.” (The Des Moines Register, 10/21, www.desmoinesregister.com/article/20131021/NEWS/131021020/?odyssey=nav%7Chead&gcheck=1) Hospice of Chesapeake shut down its computer system after becoming aware of a security breach. After learning of the breach, President Michael McHale said the nonprofit shifted to emergency mode. “We shut down our system right away.” (Hispanic Business, 10/19, www.hispanicbusiness.com/2013/10/19/hospice_of_chesapeake_shut_down_computer.htm) A recent article highlights the rewarding and important work of hospice physicians. “People tell me they think I have a sad job. That’s not true. Being a hospice physician is rewarding and fulfilling. I care for, prepare and help deliver a person to the other side.” (The Leaf Chronicle, 10/20, www.theleafchronicle.com/article/20131020/NEWS01/310200031?gcheck=1) ADVANCE CARE PLANNING NOTES Does it make sense to hire a professional to enforce your end-of-life decisions? In an article for The New York Times blog, Paula Span examines the advantages of paying “an objective decision-maker based on the priorities I have discussed with him/her before my incapacitation.” (The New York Times, 10/24, newoldage.blogs.nytimes.com/2013/10/24/hiring-an-end-of-life-enforcer/?_r=1) Leadership by the West Virginia Center for End-of-Life Care is cited as instrumental in the state’s record-breaking participation in advance care planning. “A higher percentage of West Virginians have filled out advance directives than residents of any other state, a testament to work being done by the West Virginia Center for End-of-Life Care.” (West Virginia Gazette, 10/21, www.wvgazette.com/Opinion/OpEdCommentaries/201310210066) In a YouTube video, Paula Griswold presents a webinar on advance care planning to members of the Massachusetts Association for Healthcare Quality (MAHQ, Inc.). She shares the objectives and components of a number of Massachusetts programs which together are working toward improving care transitions and honoring patient preferences at the end of life, including the MOLST project, INTERACT and IMPACT. View the full webinar here: www.youtube.com/watch?v=ii-K5pUxbAM&feature=youtube_gdata A Utah nurse has been awarded $50,000 for helping patients make and follow through on their end-of-life choices. Holli Martinez, who is receiving the large award in honor of her work with patients at the end of life, plans to use the money to improve palliative care at her hospital. (The Salt Lake Tribune, 10/24, www.sltrib.com/sltrib/news/57026279-78/care-palliative-director-university.html.csp) Why are advance care planning decisions not implemented? In short: It’s complicated. A study in The Journal of Palliative Medicine concludes, “Problems in implementation... are multifactorial and not necessarily due to deliberate nonadherence by health professionals.” The full report discusses “potential solutions to improve the clinical impact of advance care planning.” (The Journal of Palliative Medicine, 10/7, online.liebertpub.com/doi/abs/10.1089/jpm.2013.0156) PALLIATIVE CARE NOTES A study published in The Journal of Palliative Medicine concludes, “Increased use of palliative care [is] associated with improved patient functioning.” Ultimately, researchers have found that “the strongest predictor of subsequent patient functioning is their initial status.” (The Journal of Palliative Medicine, 10/7, online.liebertpub.com/doi/abs/10.1089/jpm.2013.0040) The American Cancer Society highlights Joanne Wolfe as an innovator in pediatric palliative care. “Dr. Joanne Wolfe has spent her professional career dealing with some of the most emotionally challenging situations a clinician can face: helping children with advanced cancer.” Dr. Wolfe practices under the belief that “each child needs a champion - a clinical expert who is in charge of his or her daily experience.” (The American Cancer Society, 10/23, www.cancer.org/research/acsresearchupdates/joanne-wolfe-innovating-pediatric-palliative-care) CAREGIVER NOTES An article on National Public Radio’s website highlights the positive experiences of family caregivers. “The stereotype of caring for a family member is that it’s so stressful it harms the caregiver’s health. But that’s not necessarily so.” (NPR, 10/16, www.npr.org/blogs/health/2013/10/16/235384054/family-caregiving-can-be-stressful-rewarding-and-life-affirming) The Journal Star offers seven tips for when someone you love is dying. The tips include: “Find out answers to typical end-of-life questions”; Express emotions openly and honestly; and listen carefully for any messages your loved one would like to convey.” (The Journal Star, 10/22, journalstar.com/niche/neighborhood-extra/senior-scene/care-tips-for-when-someone-you-love-is-dying/article_bfc2694f-a4f0-52ab-b48b-80fdf9dd601c.html) OTHER NOTES Can we halt the dying process? An article in The Huffington Post examines the growing body of medical research that is allowing patients to survive increasingly long periods without a heartbeat. This research creates ethical questions about how far physicians should go to prevent death. (The Huffington Post, 10/21, www.huffingtonpost.com/2013/10/21/dying-process-halt-life-death_n_4136155.html) D. Clay Ackerly, MD, et al, prepared testimony for the Senate Finance Committee, on the value of Medicare in various post-acute care venues. Though the hearing was postponed indefinitely, the testimony has garnered attention. The testimony calls for more research on the effectiveness of post-acute care. “In the absence of evidence-based guidelines, well-meaning, risk-averse physicians will err on the side of prescribing post-acute care that’s more intensive than necessary even if there is little evidence that it actually improves outcomes such as readmissions,” says a blog by Ackerly et al Harvard Business Review. The links below lead to a copy of the prepared testimony. (Harvard Business Review, 10/25, http://blogs.hbr.org/2013/10/how-to-rehabilitate-medicares-post-acute-services/; McKnight’s, 10/28, http://www.mcknights.com/lack-of-data-causes-doctors-to-steer-patients-to-unnecessary-post-acute-care-experts-say/article/318186/?DCMP=EMC-MCK_Daily) Thanks to Chris Zinn and Don Pendley for contributions. Glatfelter Insurance Group provides property and liability insurance for hospices and home healthcare agencies through their Hospice and Community Care Insurance Services division. Ask your insurance agent to visit their website at www.hccis.com. Hospice News Network is published 45-47 times a year by a consortium of state hospice organizations. Copyright, 2013. All rights reserved to HNN subscribers, who may distribute HNN, in whole or part, to provider members of the subscribers'state organizations. If readers need further information, they should consult the original source or call their state association office. HNN exists to provide summaries of local, state and national news coverage of issues that are of interest to hospice leaders. HNN disclaims all liability for validity of the information. The information in HNN is compiled from numerous sources and people who access information from HNN should also research original sources. The information in HNN is not exhaustive and HNN makes no warranty as to the reliability, accuracy, timeliness, usefulness or completeness of the information. HNN does not and cannot research the communications and materials shared and is not responsible for the content. If any reader feels that the original source is not accurate, HNN welcomes letters to the editor that may be shared with HNN readers. The views and opinions expressed by HNN articles and notes are not intended to and do not necessarily reflect views and opinions of HNN, the editor, or contributors. Only subscribing state hospice organizations have rights to distribute HNN and all subscribers understand and agree to the terms stated here. Hospice News Network is a compendium of national and international news and distributed by the Oregon Hospice Association (OHA) to its supporters. Information contained in Hospice News Network does not necessarily reflect the opinion of the Oregon Hospice Association. If you have news items to submit, would like to receive the Network, or would like to be removed from the list please contact Deborah Jaques, jaq...@oregonhospice.org.
Improving Quality of Life at the End of Life    SAVE THE DATE    April 7-8, 2014    Spring Intensive   presented by Washington  State Hospice & Palliative  Care Organization and  Oregon Hospice  Association    SAVE THE DATE  April 15-16, 2014 Coding Conference   presented by Oregon  Association for Home  Care and Oregon Hospice  Association  Follow us on Facebook! HNN expresses deepest thanks to Glatfelter Insurance Group, the national sponsor of Hospice News Network. Glatfelter continues its sponsorship in 2013. Glatfelter Insurance Group provides property and liability insurance for hospices and home healthcare agencies through the Hospice and Community Care Insurance Services division. Ask your insurance agent to visit their website at www.hccis.com.
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