Literature Review

State association launches support program for home, hospice, personal care workers The Journal Gazette, Fort Wayne, IN; by Lisa Green; 10/15/24 A statewide association for home and hospice care professionals is launching a support program today with features including training and one-on-one counseling to help with workforce retention. The CARE (Creating Action and Resources for Employees) Connect program is billed as the first of its kind in the U.S., a news release said. A recent report released by MissionCare Collective indicates that caregivers are three times more likely to suffer from anxiety and depression, and 21% of caregivers nationwide self-report poor mental health. And 55% of those workers receive some form of federal or state assistance, the Indiana Association for Home and Hospice Care said in a news release announcing the new support program.

AAHPM Board President: Telehealth access ‘critical’ for hospice patientsHospice News; by Jim Parker; 10/17/24 The forthcoming expiration of telehealth flexibilities implemented during the pandemic could have a devastating impact on vulnerable populations, including those receiving hospice or palliative care. This is according to Dr. Holly Yang, board president of the American Academy of Hospice and Palliative Medicine (AAHPM). Currently, temporary federal rules allowing for greater access to telehealth are set to expire on Dec. 31. While legislation is in play to extend them, the outcome is uncertain, and the end of the year is approaching. Hospice News sat down with Yang to discuss the importance of these flexibilities and how their impending departure could impact patients and families, particularly those in rural areas or with limited mobility, poor health equity or social determinants of health needs.

Update on 3 nonprofit hospices impacted by Helene Hospice & Palliative Care Today; Chris Comeaux with Cordt Kassner and Joy Berger; 10/17/24Chris Comeaux shared updates on hospices impacted by the recent natural disaster. While no patients or staff were lost, some completely lost their homes or experienced significant property damage.  The final loss of life remains uncertain due to unaccounted people. Hospices nationally have shown unity in supporting local counterparts through financial aid, supplies, and volunteer efforts coordinated by many nonprofits. Certain areas may lack electricity until March. Hospices face challenges like displaced skilled nursing facilities, but resources are being mobilized. Chris announced a tabletop discussion in November to learn from this experience and highlighted the need for continued patient monitoring, especially in evacuation zones. To read more and contribute:

Advice from a pumpkin: be well-rounded, get plenty of sunshine, give thanks for life's bounty, have thick skin, keep growing, be outstanding in your field, think big! ~ Unknown

Forbes Leadership Strategy: 5 reasons you should seek to work with people who think differently Forbes; by Kate Vitasek; 10/17/24 One of the most common pitfalls we see in the business world is when organizations exclusively work with people who think like they do. While at first glance, this could seem like it would help the organization become more unified, in the long run, it can actually do more harm than good. Instead, you should seek to work with people who think differently from you. By bringing in people with unique perspectives and backgrounds, you can unlock a host of valuable benefits that will serve you well in both the short- and long-term. 

BCBS reaches record antitrust settlement for $2.8B Becker's Payer Issues; by Jakob Emerson; 10/16/24  The Blue Cross Blue Shield Association, along with the 33 independent BCBS companies, have agreed to pay $2.8 billion to settle antitrust claims from healthcare providers, marking the largest settlement of its kind in the healthcare industry. In addition to the cash settlement, the plaintiffs stated in an Oct. 14 filing in Alabama federal court that BCBS plans must implement significant operational changes across 16 categories. These changes include how BCBS processes claims, communicates, contracts with, and makes payments to providers. The new operational requirements are expected to alleviate administrative burdens and inefficiencies experienced by providers, according to the plaintiffs' counsel. The settlement applies to providers who treated BCBS members between July 2008 and October 2024. The tentative agreement still requires approval from U.S. District Judge R. David Proctor. The BCBS Association denies the allegations made in the lawsuit.

CMS grants temporary relief for home health, hospice agencies affected by hurricane McKnights Home Care; by Adam Healy; 10/15/24 The Centers for Medicare & Medicaid Services has issued several temporary flexibilities intended to help hospices and home health agencies affected by Hurricane Helene continue to provide care amid the emergency. During the emergency period, home health providers may take advantage of extended deadlines for quality reporting and patient assessment requirements, according to CMS. The agency communicated last week that it would permit delayed Outcome and Assessment Information Set submissions, and it also extended the five-day completion requirement for patients’ comprehensive assessments to 30 days. These patients assessments may also be conducted remotely or by record view — a departure from the typical in-person requirement — during the temporary emergency period. CMS said that this change will allow patients to be cared for in the environment of their choice, reduce impacts on acute care and long-term care facilities, and maximize clinicians’ ability to care for patients with the greatest acuity.

Atria to exit home care business to focus on senior living portfolioMcKnights Senior Living; by Kimberly Bonvissuto; 10/16/24 Atria Senior Living is shuttering its New York-based home care subsidiary in an effort to focus on its core business of senior living. In a  “warn unit” notice filed Oct. 10 with the New York Department of Labor, Atria Home Care cited economic reasons for the layoffs of 161 employees from its Garden City, NY-based home care business, which will be effective Jan. 8. “After careful consideration, we have made the decision to discontinue operations at Atria Home Care in an effort to focus on our core business of social model senior living communities,” a spokesperson for Atria told McKnight’s Senior Living. “We are working with all home care customers and employees on a transition to other home care providers and are committed to supporting our employees and clients through these changes over the next several weeks.”

Music therapist helps patients navigate end-of-life journey on Long Island CBS New York / YouTube; by Jenna DeAngelis; 10/15/24 Music therapy helps with emotional and physical health, and now the healing power of music is being brought to hospice patients on Long Island.

Exploding physician union membership signals a significant labor market shift NJToday.net; 10/16/24 As of 2022, about 70,000 medical doctors in the United States, or about 8% of the physician workforce, belonged to a union—a notable increase of 26.8% since 2014. This shift reflects significant changes in the employment landscape for doctors, with nearly half of all physicians now working for health systems or large medical groups. The rise in union membership comes amidst broader labor movements in healthcare, highlighted by the 2023 Kaiser Permanente strike, recognized as the largest healthcare worker strike in U.S. history. While nurses have typically led these efforts, physicians and residents are increasingly exploring unionization as a means to advocate for improved pay, benefits, and working conditions. 

How physicians can navigate ethical conflicts when caring for patients Physician's Weekly; 10/14/24 ... According to the president of The Physicians Foundation, Gary Price, MD, ethics in medical care are particularly complicated regarding end-of-life choices. While decades ago, a patient’s primary care provider (PCP) would have been involved in that patient’s hospitalized care and their end-of-life decisions within the hospital, the fragmented nature of today’s healthcare system has all but eliminated PCPs from involvement in hospitalized patient care. As such, patients often make end-of-life decisions based on the guidance of doctors with whom they have no pre-existing relationship. Other factors that blur ethical lines in healthcare, adds Dr. Price, are the new state of healthcare ownership and financing. Dr. Price mentions, for instance, conflicts of interest due to the US’s biggest employer of physicians, Optum, being a subsidiary of the same company that owns UnitedHealthcare. This situation allows for an insurer who controls reimbursement and who could, as the physician’s employer, influence decisions made regarding patient care. Sadly, this influence largely comes from financial concern instead of concern for the patient’s best health outcomes. 

What the heck is a PBM, and why does it matter? Forbes; by Web Golinkin; 10/14/24... [Pharmacy Benefit Managers] PBM BasicsUnless you are a healthcare industry insider—and even if you are— it’s difficult to understand exactly how PBMs work. While they are essentially invisible to the average health plan member, PBMs have a tremendous impact on which medications are covered, the prices paid for these medications, and how patients access them. Here’s a summary of key PBM functions: Formulary Management. ... Negotiating Discounts and Rebates. ... Pharmacy Network Management. ... Claims Processing. ... Clinical Management. ... How PBMs Influence Drug Costs: Rebate System. ... High Deductible Health Plans. ... Prior Authorization and Step Therapy. ... Spread Pricing. ... What Are the Alternatives? ...

Communication gaps among clinicians may limit conversations about prognosis, hospice Healio - HemOncToday; by Jennifer Byrne; 10/16/24 Clinicians in acute or post-acute care settings may delay or avoid serious illness conversations with patients whose cancer prognoses are worsening out of deference to the patient’s oncologist, according to study findings. Researchers conducted 37 semi-structured interviews with physicians and leaders in hospital medicine, oncology, palliative care, home health care and hospice. Investigators coded and analyzed the interviews using thematic content analysis. Evaluation of the responses yielded insights into how care silos, lack of clear clinical roles and other factors may affect communication between oncologists and other clinicians. ... "We know that the 3-month window after an older adult with cancer is discharged to a skilled nursing facility can be comprised of complex medical decision making and changing preferences of care. Lack of appropriate serious illness communication during this time can result in unwanted hospitalizations and unwanted, aggressive care at the end of life."