Literature Review

Why private equity hospice investors need to re-focus on patients Hospice News; by Jim Parker; 6/7/24 As private equity investors seek out hospice and other health care transactions, they should retrain their sights on potential benefits for patients in addition to financial metrics. Driving this is a changing regulatory environment as scrutiny heats up for both hospices and the private equity firms themselves. Tightened regulation in the hospice space has led to longer, more stringent diligence processes when it comes to buying and selling provider companies. This means that potential buyers are looking hard at compliance and quality metrics before completing a deal, along with the seller’s financials.

Joel Mekler - Medicare Moments: Watch out for these latest scams New Castle News; by Joel Mekler; 6/3/24 ... Across the country, many unscrupulous hospice providers are recruiting and enrolling nonterminally ill patients for end-of-life care they do not need and then billing Medicare for services and items they may never receive. They trick beneficiaries into signing up for hospice by offering freebies, such as additional groceries, nurse visits, durable medical equipment, bus coupons, and more once they enroll. They also make false claims, such as saying “Medicare now covers cooking and cleaning services”. Or they tell beneficiaries they qualify due to age, saying “You’re now old enough to qualify for hospice!” Another tactic is giving money, with some recruiters telling beneficiaries, “You can earn $400/month if you agree to enroll in our program.” ... Tips [to consumers] to avoid hospice fraud:

Hospice of Santa Barbara celebrates 50 years with its Legacy of Compassion Campaign and a strong commitment to the futureSanta Barbara Independent; by Hospice of Santa Barbara; 6/3/24 When Hospice of Santa Barbara (HSB) officially opened its doors in 1974, it was at the forefront of a visionary movement. Only one other hospice existed in the United States at the time and a local group of Santa Barbara leaders committed to meeting the needs of people and families struggling with life-threatening illness or grieving the death of a loved one. Over the past 50 years, HSB has served tens of thousands of people. ... During this time, HSB has repeatedly adapted and grown to meet the changing needs of our community including the many community crises and disasters our community has faced. ... [As] HSB looks to their next 50 years, they see a changing landscape that greatly impacts their mission.Editor's Note: Congratulations Hospice of Santa Barbara! Thank you for pioneering our hospice movement 50 years ago and for continuing to grow and evolve your services through ongoing changes. The "one other hospice" that existed in the U.S. is Connecticut Hospice, which also continues to lead the way. Congratulations and thanks to you, too!

National aging framework outlines governmentwide initiatives promoting home-based careMcKnight's Home Care; by Adam Healy; 6/3/24The Department of Health and Human Services released a new framework for its National Plan on Aging on Thursday. The framework aims to guide a multifaceted, governmentwide approach to help caregivers and home- and community-based service providers enable older adults to age comfortably in place.

Hawaiʻi is the first state to provide palliative care coverage EIN Presswire; by Governor Josh Green, MD; 6/4/24 Governor Josh Green, M.D., and the Department of Human Services (DHS) Med-QUEST Division are pleased to announce that the Centers for Medicare and Medicaid Services (CMS) approved a new State Plan Amendment (SPA) to cover community palliative care services through Medicaid, making Hawaiʻi the first state in the nation to do so.  ... “After several years of hard work and collaboration with many community members and experts in the field, I am proud to announce that Med-QUEST is the first Medicaid program in the country to get this benefit approved,” said Governor Green. “This will greatly improve the quality of life and health outcomes for thousands of people who face serious medical conditions in our state. Hawaiʻi continues to lead the nation in innovations in health and health care.”  

Oregon reviews UnitedHealth deal for Amedisys home health, hospice The Lund Report; by Nick Budnick; 6/4/24State officials are asking members of the public to weigh on the proposed acquisition of Amedisys — a hospice and home health and company that operates in Roseburg, Salem and Portland — by an increasingly controversial health care giant called UnitedHealth Group. Inc.  UnitedHealth operates Optum, a subsidiary whose takeover of a clinic chain in the Eugene area has sparked numerous complaints. The state recently approved the company's acquisition of  The Corvallis Clinic, an 11-clinic company operating in three counties. Now, it proposes to take over the Oregon offices of a Amedisys, a publicly traded firm, and the transaction has federal officials contemplating a lawsuit to block it. UnitedHealth and Optum are under increasing scrutiny for their market dominance and allegations of anticompetitive conduct.

Behavioral health patients a challenge to nursing homesModern Healthcare; by Diane Eastabrook; 6/4/24Challenges providing care for nursing home patients with mental health and behavioral health issues are adding to discharge bottlenecks for hospitals, and the demand for such care has led some facilities to set up specialized units with additional staff just for those patients.Editor's Note: Hospice and palliative care leaders, what end-of-life, mental health and behavioral health specific education do you provide for your clinical teams, your volunteers, and family caregivers? For starters, you need to include dementia care training such as "Validation Therapy" by Naomi Feil and/or the "Positive Approach to Care" by Teepa Snow. For mental illness, examine the journal article "End-of-Life Care in Individuals with Serious Mental Illness." Click here to "Get Involved with Your Local Chapter" of the national Alzheimer's Association.

Normandy Welcomes World War II Heroes - 80th AnniversaryU.S. Department of Defense; 6/4/24World War II veterans met with cheers and applause from throngs of well-wishers as they arrived in Normandy, France, for events commemorating the 80th anniversary of D-Day. ... The number of these heroes at D-Day anniversary events in Normandy each year is diminishing, but the gratitude and awe for their service and sacrifice endures.We Honor Veterans - NHPCONHPCO; retrieved from the internet on 6/5/24We Honor Veterans empowers end-of-life care partners to meet the unique needs of America’s Veterans and their families. Our guidance and resources are focused on respectful inquiry, compassionate listening and grateful acknowledgment so that veterans can be guided through their life stories toward a more peaceful ending.Editor's Note: Thank you NHPCO for your foresight in developing this program! You identified the massive generation of WWII veterans we would lose within a window of two decades. You educated hospice organizations nation-wide and equipped us with relevant resources, while we still had time to provide meaningful support.  (Today's average age of surviving WWII veterans is 100.) 

Stepped palliative care for patients with advanced lung cancer: A randomized clinical trialJAMA; by Jennifer S. Temel, MD, Vicki A. Jackson, MPH, MD, Areej El-Jawahri, MD, Simone P. Rinaldi, MSN, ANP-BC, ACHPN, Laura A. Petrillo, MD, Pallavi Kumar, MD, Kathryn A. McGrath, MD, Thomas W. LeBlanc, MD, Arif H. Kamal, MD, Christopher A. Jones, MD, Dustin J. Rabideau, PhD, Nora Horick, MS, Kedie Pintro, MS, Emily R. Gallagher Medeiros, RN, Kathryn E. Post, PhD, RN, ANP-BC, Joseph A. Greer, PhD; 6/24A stepped-care model, with palliative care visits occurring only at key points in patients’ cancer trajectories and using a decrement in QOL to trigger more intensive palliative care exposure, resulted in fewer palliative care visits without diminishing the benefits for patients’ QOL. While stepped palliative care was associated with fewer days in hospice, it is a more scalable way to deliver early palliative care to enhance patient-reported outcomes.Publisher's note: This article was reference earlier this week in Palliative care for cancer patients is found to be as effective given virtually as in person.

National Nurses Honor Guard CoalitionJournal of Hospice and Palliative Nursing; by Betty Ferrell; 6/24As hospice and palliative care nurses, we are very familiar with the importance of rituals at the end of life or after death, which helps us to honor this sacred time. We know that funeral or memorial services offer a time to honor lives and to provide comfort to families. But how often do we pause to honor our own nursing colleagues for their lives of service?I recently learned of an incredible organization, the National Nurses Honor Guard Coalition, which is doing just this—honoring nurses through participation in their funeral services to celebrate these lives well lived and lives dedicated to our profession. ... Hearing about the Honor Guard Coalition brought tears to my eyes to think about this incredible tribute to nurses.Publisher's Note: Thanks for writing about this important group Betty! I also recently learned about the National (and state-specific) Nurses Honor Guard Coalition at the Nebraska Hospice & Palliative Care Association annual conference. A great group with a fantastic mission. 

Geriatric End-of-Life Screening Tool prediction of 6-month mortality in older patientsJAMA Open Network; by Adrian D. Haimovich, MD, PhD, Ryan C. Burke, PhD, MPH, Larry A. Nathanson, MD, David Rubins, MD, R. Andrew Taylor, MD, MHS, Erin K. Kross, MD, Kei Ouchi, MD, MPH, Nathan I. Shapiro, MD, MPH, Mara A. Schonberg, MD, MPH; 5/31/24In this prognostic study of 82,371 ED encounters within a tertiary care emergency department, the Geriatric End-of-Life Screening Tool (GEST) performed robustly on external validation, identifying 11.6% of the population as having a 30% or greater mortality risk. Compared with serious illness diagnoses, GEST provided a greater net benefit as a screening tool using decision curve analysis. The findings of this prognostic external validation study highlight the opportunity to use pragmatic, prognostic electronic health record algorithms to identify older adults in the emergency department for end-of-life care interventions.Publisher's Note: See related article posted earlier this week from McKnight's Long-Term Care News, Screening tool predicts older adults’ need for end-of-life care intervention.

Saturday newsletters focus on headlines and research - enjoy!

A moratorium on the euphemism MAIDJournal of the American Medical Directors Association; by Richard W. Sams II MD, MA (Ethics), CMD, Peter Jaggard MD, CMD; 6/24It is essential for high-quality health care for providers to adhere to the principle of truth telling, speaking with clarity and honesty. The euphemism medical aid in dying, MAID, is being mainstreamed in the medical literature by proponents of physician-assisted suicide and euthanasia. ... We recommend standardized language that accurately denotes the context and process. Provider Assisted Death by Prescription (PAD-P) and Provider Assisted Death by Administration (PAD-A) are terms that most accurately describe the process, taking into account who is prescribing or administering a lethal substance and the outcome of the actions. ... The standardized language needs to be used on death certificates so we can most accurately assess the impact that provider-assisted death is having on society. Emphasizing truth telling in morally controversial practices will foster trust among health care providers and with patients.