Literature Review

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.]

Caring with compassion: VNA Health’s commitment to holistic home health care VNA Health Live Well; by VNA Health; 7/10/24 Santa Barbara County has a unique home health care organization that is focused on serving its patients and their families without worrying about turning a profit. “As a nonprofit, VNA Health is more invested in the overall care of the patient,” said registered nurse Jadona Collier, the director of home health. “We provide programs and services that cannot be billed to Medicare or insurance.” The organization offers holistic care, meaning that, regardless of the service being used — including home health care, palliative care, hospice, and bereavement care — its medical professionals care about patients.

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.]

Employment protection for assisted dying medics BBC, Isle of Man; by Ashlea Tracey; 7/9/24 The employment rights of healthcare staff on the Isle of Man[] who choose to be part of any potential assisted dying service will be protected under new proposed laws. Members of the House of Keys previously ensured similar rights for conscientious objectors during a previous debate on the Assisted Dying Bill 2023. The Isle of Man is a self-governing British Corwn Dependency in the Iris Sea, between Great Briatin and Ireland. 

Fewer deaths after serious illness in veterans treated with PARC Care Model U.S. Medicine; by LaTina Emerson; 7/11/24 After a serious illness, veterans who received medical care via the Post-Acute Recovery Center (PARC) model experienced fewer deaths and more days outside of the hospital compared to those not treated with PARC, according to a recent study. ...  Using telehealth, PARC is administered by nurse practitioners to address the complex needs of intensive care unit (ICU) survivors as they transition from hospital to home and improve access to post-ICU care for high-risk veterans, ... Each year, “more than 100,000 veterans transition from ICUs to their home after treatment for life-threatening illnesses, but this transition presents many challenges, including unresolved acute medical issues and the lingering effects of acute organ dysfunction,” according to the study authors. ... 

Gen Z prefers burial over cremation, reversing decades of preferences trending toward cremationPR Newswire; by National Funeral Directors Association; 7/9/24 There is no shortage of social commentary on how Gen Z is redefining norms and challenging older generations to think differently, from fashion to workplace culture. But what about their perspective on death and dying? A first-of-its-kind survey conducted by the National Funeral Directors Association (NFDA) offers definitive data to show how Gen Z thinks differently about end-of-life matters for themselves and their loved ones – as well as similarities with older generations. Notable differences between the generations highlight Gen Z's unique perspective, even compared to Millennials who are the closest in age, highlighting a pivot in end-of-life preferences to come:

How Hospice of the Chesapeake is innovating bereavement care, family support Hospice News; by Jim Parker; 7/4/24 Maryland-based Hospice of the Chesapeake has been pursuing innovation in its bereavement and caregiver support programs. The nonprofit hospice and palliative care provider offers grief care to its entire community regardless of whether a family member was one of their patients. Out-of-pocket payments for those services are on a sliding scale. To expand its reach, Hospice of the Chesapeake works with organizations like schools, senior living communities and other community partners, according to Faith Fitzgerald, director of community support programs for the hospice.

Judge Realty partners with Hospice Savannah to offer home modification to support aging in placeSavannah Business Journal Staff Report; 7/8/24Judge Realty recently announced a partnership with Hospice Savannah to encourage and support aging in place. Judge Property Management, a division of Judge Realty, is working in conjunction with Hospice Savannah’s CAPABLE+ program to help older adults live independently with strategic support in the privacy of their home environment. ... Hospice Savannah’s CAPABLE program provides a support team, including a Registered Nurse, an Occupational Therapist and a Handyworker who offer home visits and provide limited care for older adults, which can decrease hospitalization and reduce healthcare costs. The standard CAPABLE program is available as a free service for low-income adults age 62 or older in Chatham, Bryan Effingham or Liberty County who are cognitively intact, but experiencing some difficulty bathing, dressing, grooming, eating or walking.

CMS Innovation Center launches Guiding an Improved Dementia Experience [GUIDE] Model, announces participantsCMS press release; 7/8/24The Centers for Medicare & Medicaid Services (CMS) is pleased to announce the launch of the Guiding an Improved Dementia Experience (GUIDE) Model, with almost 400 participating organizations building Dementia Care Programs (DCPs) serving hundreds of thousands of Medicare beneficiaries nationwide.Publisher's Note: Downloadable participant list here. By my brief estimate, approximately 10% of current participants are hospices. Who's participating in your state?

The Physician-Focused Payment Model Technical Advisory Committee (PTAC) listening session 2: Complex chronic conditions [including Ira Byock, MD, FAAHPM, and Betty Ferrell, RN, PhD]Press release; 7/4/24PTAC held a 2-day meeting on Addressing the Needs of Patients with Complex Chronic Conditions or Serious Illnesses in Population-Based Total Cost of Care (PB_TOC) Models. [Presentations include Ira Byock, MD, FAAHPM: Patient perspectives & doctors' roles in caring well through the end of life (timestamp 33:53) and Betty Ferrell, RN, PhD: Optimizing the mix of palliative care and end-of-life care in PB-TCOC Models (timestamp 48:32).]

Clinician- and patient-directed communication strategies for patients with cancer at high mortality risk JAMA Network Open - Oncology; by Samuel U. Takvorian, MD, MSHP; Peter Gabriel, MD, MSE; E. Paul Wileyto, PhD; Daniel Blumenthal, BA; Sharon Tejada, MS; Alicia B. W. Clifton, MDP; David A. Asch, MD, MBA; Alison M. Buttenheim, PhD, MBA; Katharine A. Rendle, PhD, MSW, MPH; Rachel C. Shelton, ScD, MPH; Krisda H. Chaiyachati, MD, MPH, MSHP; Oluwadamilola M. Fayanju, MD, MA, MPHS; Susan Ware, BS; Lynn M. Schuchter, MD; Pallavi Kumar, MD, MPH; Tasnim Salam, MBE, MPH; Adina Lieberman, MPH; Daniel Ragusano, MPH; Anna-Marika Bauer, MRA; Callie A. Scott, MSc; Lawrence N. Shulman, MD; Robert Schnoll, PhD; Rinad S. Beidas, PhD; Justin E. Bekelman, MD; Ravi B. Parikh, MD, MPP; 7/1/24 Serious illness conversations (SICs) that elicit patients’ values, goals, and care preferences reduce anxiety and depression and improve quality of life, but occur infrequently for patients with cancer. Behavioral economic implementation strategies (nudges) directed at clinicians and/or patients may increase SIC completion. ... In this cluster randomized trial, nudges combining clinician peer comparisons with patient priming questionnaires were associated with a marginal increase in documented SICs compared with an active control. Combining clinician- and patient-directed nudges may help to promote SICs in routine cancer care.

All I know today is that you can think that what you’ve done is only the flap of a butterfly wing, when it’s really a thunderclap. And both can result in a hurricane. ~Catherine McKenzie, Fractured