Literature Review

The number 1 mistake people make when trying to live a meaningful life with zero regrets, from a hospice doctor NBC 7 San Diego, CA; by Dr. Jordan Grumet; 1/24/25... As a hospice doctor, I spend a lot of time with people facing the end of their lives. I've seen firsthand why this belief can lead to anxiety in up to 91% of people at some point in their lives. My response is always the same: You don't find purpose — you create it. It's not about stumbling upon a fully formed sense of purpose. Instead, it's about identifying the inklings in your life that light you up. I call them "purpose anchors" — and they're clues you can use to build a meaningful life with few or no regrets.  ...

Johnson & Johnson swallows another drugmaker in $14.6 billion dealSherwood News; by J. Edward Moreno; 1/13/25J&J has spent at least $56.5 billion on acquisitions in the past five years. Johnson & Johnson announced Monday that it would acquire drugmaker Intra-Cellular Therapies for $14.6 billion, marking its latest bid for growth via swallowing a smaller company. Intra-Cellular Therapies makes Caplyta, a drug that treats schizophrenia, bipolar disorder, and major depressive disorder. The deal comes right as generics for J&J’s blockbuster psoriasis drug Stelera are set to enter the market.

NPHI supports lawsuit to ensure proper implementation of Hospice Special Focus Program National Partnership for Healthcare and Hospice Innovation, Washington, DC; Press Release; 1/16/25Today, a lawsuit was filed by the Texas Association for Home Care & Hospice; Indiana Association for Home & Hospice Care; Association for Home & Hospice Care of North Carolina; South Carolina Home Care & Hospice Association; and Houston Hospice. The lawsuit challenges CMS’s implementation of the hospice Special Focus Program (SFP) as unlawful and arbitrary. We acknowledge that Houston Hospice, an NPHI member, is one of the plaintiffs in this legal action, and we are committed to supporting them and others impacted by the SFP or the accompanying excel files. The hospice Special Focus Program (SFP), conceived and passed on a bipartisan basis as a part of the HOSPICE Act in 2021, was designed to address poor-quality hospice providers by offering them additional support and technical assistance to ensure compliance with the Medicare Hospice Conditions of Participation. NPHI is extremely disappointed that CMS has departed from that Congressional intent, transforming the hospice SFP into a burden for many well-meaning hospices, with an algorithm for identifying providers based on inaccurate data and including elements that are not referenced in the statutory language. ... NPHI fully supports the litigation filed today, which aims to direct CMS to comply with the spirit and intent of the statute and regulations. [Click on the title's link to continue reading.]

Medicare to Veterans Affairs cost shifting—A challenging conundrumJAMA Health Forum; Kenneth W. Kizer, MD, MPH, DCM; Said Ibrahim, MD, MPH, MBA; 12/24In this issue, Burke et al highlight how costs previously paid by Medicare for VA-Medicare dual eligible enrollees are now being paid by the VA under the VCCP [Veterans Community Care Program]. Today, there is reason to be concerned whether VA health care will be adequately funded because of the rapidly rising VCCP expenditures (driven in part by Medicare to VA cost shifting) and the impact of caring for an additional 740,000 enrollees who have entered the system in the past 2 years. This has created a $12 billion medical care budget shortfall for FY 2024. The substantial budgetary tumult that has resulted from these dynamics is adversely impacting the front lines of care delivery at individual VA facilities, leading to delays in hiring caregivers and impeding access to VA care and timely care delivery, as well as greatly straining the traditional roles of VA staff and clinicians trying to manage the challenging cross-system referral processes. The intertwined issues of Medicare to VA cost shifting and the rising costs of the VCCP present a challenging policy and programmatic conundrum.

Global challenges persist in bringing hospice care to incarcerated populationsHospice News; by Holly Vossel; 1/16/25Swelling incarcerated aging populations with unmet end-of-life care needs are straining prison systems worldwide. Recent research has uncovered some of the common strategies to address the issue that are being employed across the globe. More countries have adopted peer caregiving as a way to provide improved support for terminally ill incarcerated individuals, according to researcher Barry Ashpole. Hospice communities have increasingly forged collaborations to provide caregiving training programs in prison systems throughout the United States, United Kingdom, New Zealand and Germany, among others, according to a recent report dubbed as End-of-Life Care in the Prison Environment. The report examined global trends around end-of-life care delivery among incarcerated populations.

Hospice agency changes of ownership: An analysis of publicly available ownership data Assistant Secretary for Planning and Evaluation: Office of Behavioral Health, Disability, and Aging Policy; 1/10/25 Key Points:

If... by Rudyard KiplingIf you can keep your head when all about you    Are losing theirs and blaming it on you, If you can trust yourself when all men doubt you,   But make allowance for their doubting too; [Click the link above for the entire poem.]

Sunday newsletters focus on headlines and top read stories of the last week (in order) - enjoy!

Illness, and poetry, can transform usJAMA; Rafael Campo, MD, MA; 1/25... just as illness may alter our bodies and minds in unknowable ways, so can poetry subject us to the unexpected—through metaphor, imagery, and form—and thus can be indispensable as a guide to those in medicine seeking to provide empathetic care. Poetry becomes transformational, the shape-shifting text itself embodying the seemingly incomprehensible, making the father’s dementia and the speaker’s sense of grief, anger, and loss ultimately palpably human. Though perhaps readers can’t fully grasp the experience of Alzheimer disease, or losing one’s parent to its ravages, through poetry we can feel restored and heartened by its transformative power, “saying yes yes/we could live anywhere.”

Medicaid unwinding experiences in dual-eligible older adultsJAMA Health Forum; Renuka Tipirneni, MD, MSc; Wendy Furst, MA; Dominic A. Ruggiero, MPH; Dianne C. Singer, MPH; Erica Solway, PhD, MSW, MPH; Erin Beathard, MPH, MSW; Syama R. Patel, MPH; Andrei R. Stefanescu, PhD, MS; Jeffrey T. Kullgren, MD, MS, MPH; John Z. Ayanian, MD, MPP; Eric T. Roberts, PhD; 1/25This US national survey of low-income older adults found varying awareness of and experiences with the Medicaid unwinding process and identified cost-related access barriers among those who recently lost Medicaid. By 9 to 10 months into the unwinding process, few older adults reported hearing a lot about Medicaid unwinding and many reported not receiving any communication about needing to renew Medicaid eligibility. By the time of our survey, slightly less than half of respondents had completed a Medicaid renewal. Although the proportion of respondents who said they lost Medicaid in the last 6 months was relatively low, those who lost Medicaid were more likely to report cost-related difficulty getting care. These findings highlight the importance of addressing informational and navigational barriers among dual-eligible older adults to avoid disruptions in Medicaid coverage that may contribute to difficulties accessing care. 

Interoception, cardiac health, and heart failure: The potential for artificial intelligence (AI)-driven diagnosis and treatmentPhysiological Reports; Mahavir Singh, Anmol Babbarwal, Sathnur Pushpakumar, Suresh C Tyagi; 1/25"I see, I forget, I read aloud, I remember, and when I do read purposefully by writing it, I do not forget it." This phenomenon is known as "interoception" and refers to the sensing and interpretation of internal body signals, allowing the brain to communicate with various body systems. Dysfunction in interoception is associated with cardiovascular disorders. In the context of HF [heart failure], AI algorithms can analyze and interpret complex interoceptive data, providing valuable insights for diagnosis and treatment. By leveraging patient data, AI can personalize therapeutic interventions.

The role of health care stereotype threat in end-of-life planning among older sexual minority adultsInnovation in Aging; Meki Singleton; 12/24Healthcare stereotype threat (HCST), defined as “the threat of being reduced to group stereotypes within healthcare encounters”, may occur when social identities negatively impact healthcare experiences. Prior research has shown that individuals report experiencing HCST related to age, gender, weight, race/ethnicity, HIV status, and sexual orientation. Findings demonstrate that HCST may negatively impact comfort in healthcare decision-making while also potentially motivating older SM [sexual minority] adults to formally engage in ACP [advance care planning]. Research is needed to investigate the barriers and challenges to engaging in ACP among older SM adults and interventions to reduce HCST. 

Disproportionate use of aid in dying among people with ALS: Why ALS aid-in-dying requests are common while ALS is rareJournal of Aid-in-Dying Medicine; Carolyn Rennels, MD; Steven Z. Pantilat, MD FAAHPM, MHM; Ambereen K. Mehta, MD, MPH, FAAHPM; Allison Kestenbaum, MA, MPA, BCC-PCHAC, ACPE; Kelsey Noble, DO; Jessica Besbris, MD; Ali Mendelson, MD; Kara Bischoff, MD; 12/24People with amyotrophic lateral sclerosis (ALS) disproportionately use aid in dying. We explore aspects of the ALS experience that may help explain the higher rates of aid-in-dying requests in this disease relative to others. In particular, the desire to maintain control is prominent in the face of a relentlessly progressive disease that results in substantial disability. We also describe how the requirement for self-administration of aid-in-dying medications impacts people with ALS.