Literature Review

Stratis Health builds framework for expanding rural community-based palliative care Hospice News; by Jim Parker; 10/16/24 The health care performance improvement company Stratis Health has developed a framework for expanding access to palliative care in rural communities. The company’s strategy convenes resources and organizations that already exist in a given community to help meet patient’s palliative care, psychosocial, spiritual and social determinants of health needs. It leverages those resources to offer a wraparound suite of services for seniors and seriously ill patients. Hospice News spoke with Karla Weng, senior program manager for Stratis Health, about how health care providers and other stakeholders serving rural communities can come together to better serve their patients and clients. ... The field has shifted in more recent years, so that community-based really means anywhere but the hospital. It might be in a clinic. It might be home care. We’re not that prescriptive. So we have sometimes shifted to using the language “community centric.” The way that we work with communities who are interested in going down this path is helping them first to do a gap analysis and assessment of the resources that are already there in their community.  ... [Click on the title's link to continue reading.]

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. 

The best way out is always through. ~ Robert Frost

Palliative medications: what works in practice for symptom control?Nursing Times; by Sally-Anne Francis, Eunice Sirkett, Emily Anderson and Sarah Yardley; 10/14/24 This article explores the real-life challenges of managing symptoms with medication at the end of life. ... Key points:

Researchers raise concerns about the financial sector's rising role in US illness care Medical Xpress; by Mary Ann Liebert, Inc; 10/16/24 The authors of a new article in Journal of Palliative Medicine state that the "growing role of the financial sector in home health and hospice, a reflection of larger trends in U.S. health care, is concerning and has major implications for care quality unless reforms are undertaken." Co-authors Lauren Hunt, Ph.D., RN, FN, with the University of California, San Francisco, and R. Sean Morrison, MD, with the Icahn School of Medicine at Mount Sinai in New York, observe that home health and hospice began as nonprofit organizations with close ties to their communities. However, the overwhelming majority are now for-profit entities, many of which have become targets for private equity buyouts. The authors note that "big business's emphasis on maximizing profit can be at odds with patient welfare. Indeed, a substantial body of evidence now demonstrates that care quality is consistently worse in for-profits as compared to nonprofits," they state. The authors further express concern that "pressure to achieve high returns on very short-term time horizons may conflict with the need for longer-term investments in quality, training, and staffing, thus reducing care quality.

Big Bend Hospice opens new community-built field office in Jefferson County Business Wire, Tallahassee, FL; by Big Bend Hospice; 10/15/24 Big Bend Hospice has opened a new field office in Jefferson County, located in the heart of Monticello’s historic district, replacing its previous location at 187 Walnut St. The new office, made possible by the Big Bend Hospice Jefferson County Advisory Council and the community’s dedicated fundraising efforts, will serve as the hub for Big Bend Hospice’s clinical staff and volunteers, who provide in-home patient care throughout Jefferson County. Built entirely through local donations over the past nine years, the project is a testament to the strength and commitment of the community. “This field office reflects the deep support Jefferson County has for hospice care,” said Michael Eurich, senior director of strategy, policy, and innovation at Big Bend Hospice.

AI and change management: Navigating the human side of AI Method; by Jaon Rome; 10/14/24 ... An effective AI change management strategy must consider multiple employee groups — including front-, middle-, and back-office workers — whom AI implementation most affects. How you talk about AI and introduce AI tools to your employees influences how your people perceive AI, which affects their acceptance and adoption of it. ... Your AI investments’ success depends on your people. They must buy into AI’s value, see themselves as innovating with AI rather than training their replacements, and use the AI tools you’ve built in their day-to-day work.

What we know matters, but who we are matters more. ~ Brené Brown

From bedside to mountaintop, she advocates for meaningful palliative care UCLA Health; by Jennifer Karmarker; 10/14/24 In a society that places a premium on prolonging life, celebrating the end of life is sometimes overlooked. Lindsay Brant, BSN, RN, CCRN, EOLD, MFA, is on a mission to change that. Brant started her work as a critical care nurse in the cardiothoracic ICU at UCLA Health in 2013. Since then, her journey has taken her from the bedside of the critically ill to a mountain retreat in New Mexico to remote high-altitude villages in the Himalayas and back again. Along the way, she’s discovered something she is passionate about sharing: Death can be a beautiful experience, if we let it. “It’s that constant question of how can end of life be as peaceful and meaningful as possible for the patient and their loved ones,” Brant says. 

The daily balancing act of value-based cancer care The American Journal of Managed Care (AJMC); by Laura Joszt, MA; 10/14/24 In value-based care, there’s a daily balancing act to achieve quality outcomes, cost reduction, and patient care improvements, explained Stuart Staggs, vice president of transformation, quality, and shared services for The US Oncology Network (Network). At the Institute for Value-Based Medicine event, cohosted by The American Journal of Managed Care (AJMC) and Minnesota Oncology, Staggs kicked it off with what he called a “practical look at value-based care.” He highlighted 4 main areas: quality, improvement, adoption, and cost. ... The area of improvement that the Network wanted to focus on was advanced care planning and better supporting and engaging patients and their families around hospice and life support. During the OCM, the Network better engaged patients and families around hospice care and encouraged practices to have difficult conversations. Not only does this improve patient experience by providing them the end-of-life care that they want, but there is also a cost factor. Patients who don’t receive hospice care spend significantly more in the last 30 to 60 days, Staggs said.

Managing the hospice payment cap by balancing Length of Stay Hospice News; by Jim Parker; 10/15/24 Careful management of the hospice aggregate cap is key to providers’ sustainability as regulatory scrutiny continues to heat up. The cap is designed to prevent overuse of hospice, put controls on Medicare spending and foster greater access to care among patients. For Fiscal Year 2024, the U.S. Centers for Medicare & Medicaid Services set the cap at $33,394. In 2025, this will rise to $34,465. “While the cap is a beneficiary driven cap, meaning the reimbursement allowed per Medicare beneficiary, it is not assessed at the beneficiary level, but rather in the aggregate at the agency provider number level for all beneficiaries served by the agency in the cap,” Rochelle Salinas, vice president of operations for CommonSpirit Health at Home, said. “This allows for greater flexibility in providing care to those in need.” ... [Click on the title's link to continue reading.]

Minnesota-based Saint Therese to acquire St. Mary of the Woods Senior Community in Avon, Ohio AP; by Barb Hemberger; 10/15/24 Continuing to build its footprint in the Midwest, Saint Therese, an aging care and services leader based in the Twin Cities, today announced it will acquire St. Mary of the Woods in Avon, Ohio, near Cleveland. The transition of ownership is expected to occur on December 1, 2024. This is the second acquisition for Saint Therese in two years and the second in the region, following the purchase last year of IHM Senior Living Community in Monroe, Michigan. ... Saint Therese at St. Odilia in Shoreview specializes in hospice and palliative care. Saint Therese is a nonprofit, 501(c)(3) senior care organization. 

Optum’s home-based care arm propelling growth at UnitedHealth Group Hospice News; by Jim Parker; 10/15/24 UnitedHealth Group’s subsidiary OptumHealth is a growth engine for the massive health care and insurance company. In addition to other services OptumHealth holds a substantial home health and hospice business. Optum is in the process of acquiring the home health and hospice provider Amedisys (NASDAQ: AMED), with closing expected before the end of the year, pending some regulatory hurdles. Optum last June penned its agreement to acquire Amedisys in an all-cash transaction of $101 per share, or about $3.3 billion. The Amedisys deal is among a slew of large acquisitions by Optum, which include the home health and hospice provider LHC Group and the health care tech company Change Healthcare. Optum closed its $5.4 billion acquisition of LHC Group in February 2023.