Literature Review

Becoming time rich with physician moms: Sarah Wittry and Nicole Perrotte MarketScale - Ripple of Change; by Todd Otten; 7/30/24 In today’s high-stress healthcare environment, physician mothers face the formidable challenge of balancing demanding careers with their personal lives. The conversation on work-life balance is more relevant than ever, with more women in medicine seeking ways to manage these dual responsibilities effectively. How can physician moms navigate this landscape to reclaim time for themselves without guilt? What strategies can physician moms employ to achieve a healthier work-life balance? This pressing question lies at the heart of today’s discussion on the Ripple of Change podcast. ... Key points of discussion:

How the Hospice CARE Act could change respite services Hospice News; by Jim Parker; 8/1/24 The Hospice Care Accountability, Reform, and Enforcement (Hospice CARE) Act, if enacted, would make changes to the ways hospices provide respite care. Rep. Earl Blumenauer (D-Oregon) is in the process of drafting the bill that would represent the most significant reforms to date for hospice payment and oversight. The legislation is currently in a discussion draft phase, which has been circulated among the nation’s major industry trade associations and their members for feedback. ... “There’s evidence that people who take advantage of hospice care delivered properly, actually have a higher quality of life. Oftentimes, they live longer,” Blumenauer said at Elevate. “This is an opportunity to do something in this Congress that is concrete, specific, that will save money and improve the quality of care for some of our most vulnerable people.”

Avow Kids receives transformational gift from Naples Children & Education FoundationAvow Hospice press release; 7/23/24Avow Foundation has received a generous grant of $115,000 from the Naples Children & Education Foundation (NCEF), the founding organization of the Naples Winter Wine Festival. The grant is specifically intended for Avow Kids, a program for children ages 5 - 17 that provides support and companionship to youth experiencing any type of grief. The grant will support Avow Kids’ various services, such as individual counseling, support groups, workshops, camps, music therapy, movie nights, and more.

Home health sees spending, utilization decline as hospice equivalents grow, MedPAC reportsMcKnight's Home Care; by Adam Healy; 7/19/24Though hospice spending and utilization appear to be on the rise, Medicare spending on home health has fallen amid declining utilization in recent years, according to a new report by the Medicare Payment Advisory Commission. In 2022, the year of the most recent available data, Medicare home health spending shrank to $16.4 billion. That compares to $17 billion the year prior, the report found. Meanwhile, the number of home health users declined by 6.3% from 2021, and the overall share of Medicare beneficiaries that use home health shrank by 3% from the year prior. The total number of in-person home health visits decreased by 9.6% year-over-year in 2022... Meanwhile, the hospice industry has experienced both reimbursement and utilization gains in recent years, MedPAC reported. Medicare hospice payments rose 2.7% year-over-year in 2022, while the number of beneficiaries using hospice services ticked up by 0.4%. These patients are also receiving more care; the total number of hospice days provided to beneficiaries increased by 2% in 2022.

Help improve the PEPPER ProgramPEPPER email; 7/30/24There is a temporary pause in distributing Program for Evaluating Payment Patterns Electronic Reports (PEPPERs) as the Centers for Medicare & Medicaid Services (CMS) work to improve and update the program and reporting system. This pause will remain in effect through the fall of 2024. We recognize the importance of these reports to your practice. Therefore, during this time, CMS will be working diligently to enhance the quality and accessibility of the reports. In fulfilling this commitment, CMS seeks responses to a series of questions listed in the Request for Information (RFI). These questions will provide CMS with information that may be used to reevaluate PEPPERs and improve the effectiveness and accessibility of the program. The RFI (PDF) is available here. Responses are due on or before 08/19/2024 and must be provided via online submission at the following address: CBRPEPPERInquiries@cms.hhs.gov. 

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.

Start of the COVID-19 pandemic and palliative care unit utilization: a retrospective cohort studyJournal of Pain and Symptom Management; by Michael Bonares, Kalli Stilos, Madison Peters, Lise Huynh, Debbie Selby; 7/24Despite historically poor palliative care units (PCU)/hospice access, the COVID-19 pandemic created circumstances that may have enabled unprecedented utilization in individuals with non-cancer diagnoses in our cohort. This substantiates that so long as it is concordant with their goals, individuals with non-cancer diagnoses can have enhanced PCU/hospice utilization.