Literature Review

Pain Management at the End of LifeJournal of Hospice and Palliative Nursing; HPNA position statement; 8/24Pain management is essential from the time of diagnosis of a serious illness and throughout the disease trajectory. Unfortunately, the prevalence of pain in those with serious illness remains unacceptably high. In most cases, pain experienced by people with advanced disease can be prevented or relieved through optimal care, yet studies reveal that patients continue to experience uncontrolled pain in the final weeks, days, and hours of their lives...

CMS 2025 Hospice Final Rule [published 8/6/24]: Additional responses

Hospital assets before and after private equity acquisitionJAMA; by Elizabeth Schrier, Hope E M Schwartz, David U Himmelstein, Adam Gaffney, Danny McCormick, Samuel L Dickman, Steffie Woolhandler; 7/24Private equity firms spent $505 billion on health care acquisitions between 2018 and 2023. Financial infusions may augment resources for care. However, firms have sometimes sold acquired hospitals’ land and buildings, repaying investors with proceeds and burdening hospitals with rent payments for facilities they once owned. We assessed changes in hospitals’ capital assets after private equity acquisition. After private equity acquisition, hospital assets decreased by 24% relative to that of controls during 2 years. Private equity acquisitions appear to have depleted, rather than augmented, hospital assets. Although funds from asset drawdowns might be redeployed to enhance care or efficiency, previous studies suggest such effects may not occur.

AI And Health Insurance Prior Authorization: Regulators Need To Step Up OversightHealth Affairs; by Carmel Shachar Amy Killelea Sara Gerke; 7/24Artificial intelligence (AI)—a machine or computer’s ability to perform cognitive functions—is quickly changing many facets of American life, including how we interact with health insurance. AI is increasingly being used by health insurers to automate a host of functions, including processing prior authorization (PA) requests, managing other plan utilization management techniques, and adjudicating claims. In contrast to the Food and Drug Administration’s (FDA’s) increasing attention to algorithms used to guide clinical decision making, there is relatively little state or federal oversight of both the development and use of algorithms by health insurers.

Improving Pain Self-Management Among Rural Older Adults With CancerJAMA Network; by Megan J Shen, Tammy Stokes, Sarah Yarborough, Jill Harrison; 7/24Is the adapted version of Cancer Health Empowerment for Living without Pain (CA-HELP) feasible, acceptable, and able to improve pain outcomes among older adults with cancer living in rural settings? Study results highlight a potentially low-cost, low-burden intervention designed to improve pain communication and reduce pain severity and pain misconceptions among older adults with cancer in rural settings.

[UK] Recognising dying in motor neurone disease: a scoping reviewPalliative Medicine; by Elizabeth Abbey, Maimoona Ali, Matthew Cooper, Paul Taylor, Catriona R Mayland; 8/24Dying in motor neurone disease is associated with patterns of symptoms and signs, however evidence is limited compared with other terminal conditions and requires further exploration. The characteristic sudden and unpredictable terminal decline is a key barrier to recognition of dying by healthcare professionals. Dyspnoea, anxiety and pain were the most common symptoms associated with the dying phase. Worsening respiratory function, the development of specific new symptoms and deteriorating symptom control suggested approaching death. No studies reported changes in vital signs or biomarkers associated with dying.

Four Years And More Than 200,000 Deaths Later: Lessons Learned From The COVID-19 Pandemic In US Nursing HomesHealth Affairs; by R. Tamara Konetzka, David C. Grabowski, Vincent Mor; 7/24Nursing home residents and staff were disproportionately affected by the COVID-19 pandemic, drawing attention to long-standing challenges of poor infection control, understaffing, and substandard quality of care in many facilities. Evolving practices and policies during the pandemic often focused on these challenges, with little effect. Despite the emergence of best practices to mitigate transmission of the virus, even the highest-quality facilities experienced outbreaks, indicating a larger systemic problem, rather than a quality problem at the facility level. Here we present a narrative review and discussion of the evolution of policies and practices and their effectiveness, drawing on evidence from the United States that was published during 2020–23.

Sometimes I look back on my life and I am seriously impressed I am still alive.

Virtual reality for pain management in hospitalized patients with cancer: A randomized controlled trialCancer; by Hunter Groninger, Diana Violanti, Mihriye Mete; 4/24Among hospitalized adult patients with moderate-severe pain related to cancer and cancer therapies, VR provided more nonpharmacologic pain relief than active control and this benefit sustained long after conclusion of the intervention.

Hospice care uplifts and encourages patients' families during difficult timesWLOS (NC); 8/6/24When a loved one becomes ill and needs extra assistance, it is vital for family members and caregivers to step up to the challenge. It is also important to find support that prioritizes what is important to the patient and their kin. Four Seasons, The Care You Trust, emphasizes that they are always “here for you,” but what does that mean? Learn the answer through the words of Larry Moore, who found the resources and guidance he needed from Four Seasons as he served as the primary caregiver for his mother, Joan, while she was living with dementia... That’s the highlight of my Four Seasons story. The care that they give the patient is phenomenal, but I think people expect that. What they don’t realize is the care Four Seasons gives to the family is equally as important. Don’t pass up the opportunity to ask them for help.”

Closing the gap in value-based care: Lessons from provider-led ACO experienceHealth Affairs; by Clive Fields, Gary M. Jacobs; 8/6/24Achieving the Centers for Medicare and Medicaid Services’ (CMS’s) goal to bring every Medicare patient into a value-based care (VBC) arrangement by 2030 requires bold action. With six years left to achieve that goal (as of January 2024), only half of current Medicare beneficiaries are aligned with an accountable care organization (ACO) providing care within a VBC arrangement. This gap is large, but accelerated participation and reaching the 2030 goal remain possible. To close the gap, policy makers must apply the lessons learned from the real-world experience of models developed by the Center for Medicare and Medicaid Innovation (the Innovation Center), the Medicare Shared Savings Program (MSSP), and other CMS demonstrations. ACOs participating in the MSSP and alternative payment models developed by the Innovation Center have proven that they can deliver high-quality care, improve the patient experience, and generate savings for Medicare. The Congressional Budget Office has found that physician-led ACOs and ACOs with a larger proportion of primary care providers, as opposed to specialists or clinicians in non-primary care settings, generate greater savings.

CVS launches $2B in cost cuts, Aetna president outModern Healthcare; by Fiona Rutherford; 8/7/24CVS Health Corp. lowered its 2024 earnings outlook for the third straight quarter and announced cost-cutting measures to save $2 billion over several years as healthcare expenses continue to soar. The company also announced the departure of Brian Kane, who took the helm as the president of the Aetna insurance unit just under a year ago. CVS Chief Executive Officer Karen Lynch and Chief Financial Officer Tom Cowhey will temporarily take over his duties during the search for a successor. CVS is slashing spending and streamlining operations as its insurance arm faces pressure from rising US medical costs. Aetna accounts for about a third of the company’s revenue, but its struggles this year are largely to blame for a downturn in earnings and slump in the stock price.