Literature Review

Chevron deference derailed The Rowan Report; by Kristin Rowan; 7/12/24 ... Chevron Deference in Home Health: Since the advent of the PDGM model, CMS has calculated payment rates based on its interpretation of budget neutrality. The National Association for Home Care and Hospice [NAHC] has disputed the validity of both the interpretation of budget neutrality and the formulas used to calculate it. Last year’s 2024 CMS Proposed Rule cut payment rates even further with a 2.890% Budget Neutrality permanent payment rate adjustment and a temporary rate adjustment to account for alleged overpayments from 2020-2022. The lawsuit filed against CMS in response to the 2024 Final Rule was dismissed. NAHC began pursuing an administrative review with CMS. [Click on the title's link to continue reading the discourse between CMS and NAHC, specific to home health.]

[Global Partners in Care] 25 Years of Compassion and Impact eHospice; 7/9/24 In 2024, Global Partners in Care (GPIC) celebrates its 25th anniversary. Over the past 25 years, GPIC has been dedicated to enhancing access to compassionate care for individuals and families across the globe who face serious illness, death and grief. This silver anniversary is a significant milestone in the history of the organization. Not only does it provide an occasion to reflect on the impact the organization has made, but it also provides an opportunity to consider numerous future possibilities. 

Emory receives $5 million grant to improve geriatric care and education Saporta Report; by Emory University, Atlanta, GA; 7/16/24 Emory University has been awarded a $5 million cooperative agreement by the U.S. Health Resources and Services Administration (HRSA) to enhance geriatric care and education for health care workers in Georgia’s urban and rural areas. This five-year funding will support Georgia Gear (Geriatrics Workforce Enhancement Program), operated through the Department of Family and Preventive Medicine at Emory University School of Medicine. ... The Georgia Gear program will partner with organizations including Georgia Memory Net, the Georgia Department of Public Health, Georgia Area Health Education Center, the Technical College System of Georgia, Emory Healthcare, the Atlanta VA Health Care System, and the American Academy of Hospice and Palliative Medicine (AAHPM).

C-TAC: CMS’ ‘Palliative’ Definition in 2025 Proposed Hospice Rule ‘Misaligned, Problematic’ Hospice News; by Holly Vossel; 7/12/24 Efforts to establish potential payment mechanisms for high-acuity palliative services within the Medicare Hospice Benefit will require greater clarity from regulators, according to the Coalition to Transform Advanced Care (C-TAC). The U.S. Centers for Medicare & Medicaid Services’ (CMS) 2025 proposed hospice payment rule contained a request for information (RFI) on the potential implementation of reimbursement pathways for “high intensity palliative care services,” such as chemotherapy, blood transfusion and dialysis. CMS in its proposed rule indicated that, “Hospice care changes the focus of a patient’s illness to comfort care (palliative care) for pain relief and symptom management from a curative type of care.” C-TAC’s recommendations are as follows: [Click on the title's link to read more.]

When you know you might forget everything: Living with the Alzheimer’s gene Intelligencer; by Amelia Schonbek; 7/16/24 In 2017, 23andMe began offering tests for the genetic risk of developing certain health conditions like celiac disease, Parkinson’s, and late-onset Alzheimer’s. The Alzheimer’s test will tell you if you have the gene variant APOE4, which means you have an increased likelihood of developing the disease. One in four people carry a single copy of the gene, but 2 to 3 percent of the population have two copies — one from each parent — and have a much higher probability. As with all of 23andMe’s upcharged “Health Predisposition Reports,” the sell on it was self-empowerment: Once you know, you can plan, allowing you to take charge of your well-being. 

NAHC-NHPCO Alliance comments on Hospice CARE Act HomeCare; 7/16/24 The NAHC-NHPCO Alliance submitted a comment letter to the office of Rep. Earl Blumenauer (OR-3) on the discussion draft of the Hospice Care Accountability, Reform, and Enforcement Act (Hospice CARE Act), along with an overview and section-by-section summary. The Hospice CARE Act focuses on hospice payment reform and program integrity. The two trade organizations said they have worked closely with Blumenauer for years on these issues and are committed to continuing the dialogue to secure optimal outcomes for hospice providers and the continued delivery of quality care for patients and their families.

[Australia] Methadone versus other opioids for refractory malignant bone pain: a pilot randomised controlled studySupportive Care in Cancer; Merlina Sulistio, Alexandra Gorelik, Hoong Jiun Tee, Robert Wojnar, David Kissane, Natasha Michael; 7/24Refractory cancer-induced bone pain (CIBP) affects a patient's functional capacity and quality of life, but there is limited evidence to guide opioid choice. We assessed the feasibility, tolerability and possible efficacy of methadone rotation (MR) compared to other opioid rotations (OOR) in this cohort. Of 51 eligible participants...both groups displayed significant reduction in average...and worst pain...and total pain interference score. Oral morphine equivalent daily dose was reduced significantly in MR compared to the OOR group (d = - 0.8, p = 0.05). The incidence of opioid-related adverse events following MR was unchanged but lower in the OOR group. There were no within-group or between-group differences in satisfaction with analgesia at the end of the study.

Assessing pediatric resident needs in grief and bereavement educationJournal of Pain and Symptom Management; Hannah Reuman, Scott H Maurer, Kelly Harris, Amanda W Brown; July 2024Pediatric [medical] residents care for dying children during training. Few educational efforts focus on helping trainees better understand their own grief process and the supports available to them and their patients' families. This work aims to assess pediatric residents' needs and preferences for content included in a curriculum on grief and bereavement. Conclusion: Pediatric residents indicate a strong desire for structured curricula on grief and bereavement focusing on resources that exist for families, approaches to grieving as a healthcare professional, and better understanding the experiences of bereaved families. These data may inform educators on priorities in training and support of pediatric residents on grief and bereavement.

Everyday ethics or deference to expertise: experiences of pediatric palliative care teams with ethics consultancyJournal of Palliative Medicine; Anessa M Foxwell, Connie M Ulrich, Jennifer K Walter, Meaghann S Weaver; 7/24Little is known about the extent to which pediatric palliative care (PPC) clinicians are engaged in ethics consults or how they perceive interactions with ethics consultants. Online survey distributed to members of the American Academy of Pediatrics and American Academy of Hospice and Palliative Care pediatric and ethics section and special interest groups in the United States. Eighty-six responses were obtained (response rate 45%) from PPC teams in 70 different children's hospitals located in 34 states. Almost all (97%) reported a functional ethics consult service such that PPC is not expected to meet the ethics need of the institution. A person involved on the PPC team also performed ethics consults in half (49%) of the settings, predominantly the PPC physician. Most respondents who perceive PPC teams engage in ethics-relevant work as part of their everyday PPC work. Formal ethics training was lacking among PPC members involved in ethics consults with few ethics degrees (15%), certifications (6%), or fellowships (2%). Discord (67%), conflict (49%), limitations to treatment (48%), and distress (41%) were cited as the most frequent reasons for which PPC teams consult ethics. PPC respondents identified role clarity, coordinated engagement, timely presence, and open communication as strong PHCE consultant practices. Conclusions: PPC team members performing ethics consults may benefit from additional ethics education and training.

Top ten tips palliative care clinicians should know before their patient undergoes surgery? Journal of Palliative Medicine; by Rachel Hadler, Lara India, Angela M Bader, Orly N Farber, Melanie L Fritz, Fabian M Johnston, Nader N Massarweh, Ravi Pathak, Sandra H Sacks, Margaret L Schwarze, Jocelyn Streid, William E Rosa, Rebecca A Aslakson; 7/15/24 online ahead of print Many seriously ill patients undergo surgical interventions. Palliative care clinicians may not be familiar with the nuances involved in perioperative care, however they can play a valuable role in enabling the delivery of patient-centered and goal-concordant perioperative care. ... This article, written by a team of surgeons and anesthesiologists, many with subspecialty training in palliative medicine and/or ethics, offers ten tips to support palliative care clinicians and facilitate comprehensive discussion as they engage with patients and clinicians considering surgical interventions.

Tools for tomorrow: a scoping review of patient-facing tools for advance care planning Palliative Care and Social Practice; by Sean R. Riley, Christiane Voisin, Erin E. Stevens, Seuli Bose-Brill, Karen O. Moss; 6/24/24 first published online Our scoping review reveals an evolving landscape of ACP tools [Advanced Care Planning], marked by increasing diversity in delivery methods and a trend toward personalized, adaptable resources. The integration of technology and patient- and family-centered approaches signifies promising progress in end-of-life care, offering new paths for engagement with patients and families. Critics questioning the utility of ACP may need to revisit their perspectives in light of these innovative developments. Our findings highlight the need for further research on the effective implementation and integration of these tools as well as other unique approaches into healthcare systems and community-based settings. Ultimately, the continual advancement of these tools may reshape health services research, leading to more patient- and family-centered care and improving end-of-life decision-making processes outcomes for all people thereby promoting health equity.

The difference between a successful person and others is not lack of strength, not a lack of knowledge, but rather a lack of will. ~Vince Lombardi

Hospice enrollment and central nervous system–active medication prescribing to Medicare decedents with dementia JAMA Psychiatry; by Lauren B. Gerlach, DO, MS; Lan Zhang, PhD; Joan Teno, MD, MS; Donovan T. Maust, MD, MS; 7/17/24  Central nervous system (CNS)–active medications, including benzodiazepines and antipsychotics, are commonly prescribed in hospice for behavioral and physical symptom management.1 Such medications are not without risks, especially among patients living with Alzheimer disease and related dementias (ADRD), where potential harms may outweigh benefits for some patients.2 We explored the extent to which hospice enrollment is associated with CNS–active medication exposure among Medicare decedents with ADRD.