Literature Review

ONA accuses Providence of trying to sidestep state regulators as it partners with private equity Oregon Nurses Association; by ONA; 12/12/24 The Oregon Nurses Association (ONA) sent a letter to the Oregon Health Authority asking them to intervene in the recently proposed joint venture between Providence Health and private equity-backed Compassus to manage Providence’s home health and hospice program. The full letter is included below. Providence announced the so-called joint venture in October but has failed to file the proper paperwork with Oregon’s Healthcare Market Oversight (HCMO) to allow state regulators time to review the sale. Concerns from patients and caregivers have already been raised about transparency, patient care, and the potential negative effects on health outcomes in Oregon’s vulnerable communities with this joint venture.

Embracing life when nearing death The Aspen Times - Snowmass Sun; Aspen, CO; by Allison Daily; 12/13/24 Receiving a terminal diagnosis is one of life’s most profoundly difficult moments — a collision of disbelief, fear, and uncertainty. With some diseases, there’s a glimmer of hope for a miracle; with others, the focus shifts to navigating the process ahead. When Rita Hunter first asked to meet with me, I had no idea she had been diagnosed with Amyotrophic Lateral Sclerosis (ALS) or Lou Gehrig’s Disease. As we settled into my office, she got straight to the point: “I want you to help me with this last part of my life.” I left our first session rattled, but we established a clear understanding over time. She needed someone with whom she could be brutally honest — someone to discuss, without judgment, what she was willing and unwilling to endure. ... In her final days, her body let her know when it was time, and she showed extraordinary grace. She was a gift to this community, and she was a gift to me. She taught me more than I could ever give to her. Rita had become a model of how to live fully, even in the face of an unchangeable reality. Editor's note: Click on the title's link to read this inspirational story, and to learn this clinician's "treehouse" imagery intervention.

Cancer mortality in Louisiana’s correctional system, 2015-2021JAMA Network Open; Totadri Dhimal, MD; Paula Cupertino, PhD; Zijing Cheng, MS; Erika E. Ramsdale, MD; Bailey K. Hilty Chu, MD; Brian J. Kaplan, MD; Andrea Armstrong, JD, MPA; Xueya Cai, PhD; Yue Li, PhD; Fergal J. Fleming, MD, MPH; Anthony Loria, MD, MSCI; 11/24Nearly 2 million individuals are incarcerated annually in the US, predominantly low-income men from racial and ethnic minority backgrounds. The prison population is also aging, with those aged 55 years or older projected to constitute one-third of all incarcerated individuals by 2030. Imprisonment is associated with accelerated physiological aging, and national data show that incarcerated individuals have 22% higher odds of receiving a cancer diagnosis compared with the general population. Our study found that the cancer-specific mortality rate among incarcerated individuals in Louisiana was higher than the national rate but lower than the state’s, with the majority of these deaths occurring among those older than 55 years. Medical compassionate release remains an underutilized option, and the effect of providing a dignified death for families, health care professionals, incarcerated individuals, payers, and policymakers needs further evaluation.

The ISNP opportunity for hospice providers  Hospice News; by Jim Parker; 12/5/24 Hospice providers can collaborate with institutional special needs Medicare Advantage plans (ISNP) to reach patients who reside in long-term care facilities. ISNPs restrict enrollment to MA eligible individuals who, for 90 days or longer, have had or are expected to need the level of services provided in a long-term care (LTC), skilled nursing facility, a LTC nursing facility, intermediate care facility for individuals with intellectual disabilities (ICF/IDD), or an inpatient psychiatric facility. The nonprofit senior services organization Empath Health, which operates several hospices, recently partnered with the MA organization American Health Plans to bring their services to ISNP-enrolled patients.

Patient, caregiver, and clinician perspectives on the time burdens of cancer careJAMA Network Open; Arjun Gupta, MD; Whitney V. Johnson, MD; Nicole L. Henderson, PhD; Obafemi O. Ogunleye, MEd; Preethiya Sekar, MD; Manju George, MVSc, PhD; Allison Breininger, MA; Michael Anne Kyle, PhD, RN; Christopher M. Booth, MD; Timothy P. Hanna, MD, PhD; Gabrielle B. Rocque, MD; Helen M. Parsons, PhD; Rachel I. Vogel, PhD; Anne H. Blaes, MD, MS; 11/24Cancer and its care impose significant time commitments on patients and care partners. These commitments, along with their associated burden, have recently been conceptualized as the “time toxicity” of cancer care. Patients with advanced solid tumors spend approximately 20% to 30% of their days alive with health care contact. In this qualitative analysis of patients, informal care partners, and clinicians, participants highlighted the diverse sources of time burdens, how these time burdens affected care partners alongside patients, and how the time burdens extended to the wider network around them. Time burdens had outcomes ranging from causing psychosocial distress, and “seemingly short” ambulatory appointments turning into all-day affairs. These findings will guide the oncology community to map, measure, and address time burdens for persons affected by cancer.

Characteristics of health systems operating Medicare Advantage PlansJAMA Health Forum; Aaron Hedquist, MSc; Eric Yu, MPH; Pasha Hamed, MA; E. John Orav, PhD; Austin Frakt, PhD; Thomas C. Tsai, MD, MPH; 11/24Health care delivery has rapidly transitioned from independent physicians and hospitals to integrated delivery networks. More than three-quarters of inpatient facilities are affiliated with a health system. Nearly 1 in 7 MA [Medicare Advantage] beneficiaries are enrolled in system-operated MA plans, which remain a consistent source of Medicare enrollment. The findings of this study suggest that larger and church-affiliated health systems are associated with a higher likelihood of operating an MA plan. System-operated MA plans were associated with higher quality ratings and patient satisfaction than unaffiliated MA plans.

How hospice CNAs provide comfort in end-of-life care Intelligent Living; by Jennifer Barns; 12/8/24 End-of-life care is one of the most challenging yet meaningful services that healthcare professionals can offer. During such a delicate time, the role of a hospice CNA becomes essential. ... Table of Contents:

Regulators extend some telemedicine flexibilities, gauge telehealth’s ‘new path forward’ in hospice Hospice News; by Holly Vossel; 12/4/24 Regulators recently extended certain temporary telemedicine waivers granted during the pandemic, with some flexibilities now sunsetting in 2025 rather than the end of this year. The U.S. Drug Enforcement Administration (DEA) and the U.S. Department of Health and Human Services (HHS) have announced the extension of telemedicine flexibilities for the prescribing of controlled medications until Dec. 31, 2025. ... The move was made in response to feedback the agencies received from more than 38,000 comments and two days of public listening sessions. The extension allows for more time to consider a “new path forward” for telemedicine, according to the DEA and HHS. “We continue to carefully consider the input received and are working to promulgate a final set of telemedicine regulations,” the agencies stated in an announcement. “With the end of 2024 quickly approaching, DEA, jointly with HHS, has extended current telemedicine flexibilities through December 31, 2025.” The temporary rule, entitled as the Third Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications, was recently submitted to the Federal Register and will take effect/become effective Jan. 1, 2025.

Sunday newsletters focus on headlines and top read stories of the last week (in order) - enjoy!

Race and ethnicity, gender, and promotion of physicians in academic medicineJAMA Network Open; Lauren Clark, MS; Elena Shergina, PhD; Nathalia Machado, PhD; Taneisha S. Scheuermann, PhD; Nasrin Sultana, MS; Deepika Polineni, MD; Grace H. Shih, MD; Robert D. Simari, MD; Jo A. Wick, PhD; Kimber P. Richter, PhD, MPH; 11/24Medical school faculty training the next generation of physicians do not resemble the diversity of America. Compared with the US working population, American Indian, Black, and Hispanic people are underrepresented in the physician workforce. These findings indicate that preferential promotion of White men within academic medicine continues to persist in the new millennium, with racially and ethnically diverse women experiencing greater underpromotion. To achieve a workforce that reflects the diversity of the US population, this study suggests that academic medicine needs to transform its culture and practices surrounding faculty appointments and promotions.

The patient portal messaging crisisJAMA Neurology; Carrie K. Grouse, MD; Gregory J. Esper, MD, MBA; 12/24The patient portal has improved patient access to medical records and facilitated direct communication between patients and their health care teams, improving patient satisfaction, enhancing health care utilization, and increasing treatment adherence. Work associated with portal messaging has fallen primarily on physicians, requiring time outside clinical work hours to respond. Appointment access limitations have driven more asynchronous care delivery, resulting in more complex and time-consuming messages. This trend is causing higher levels of physician burnout, and female physicians are disproportionately affected. Burnout associated with excessive after-hours work in EHRs [electronic health records] is now noted among neurologists.

Promoting the resilience of health care information systems—The day hospitals stood stillJAMA Health Forum; Daniel B. Kramer, MD, MPH; Kevin Fu, PhD; 11/24On Friday, July 19, 2024, health care workers woke to emails declaring systemwide information technology (IT) emergencies. Because Crowdstrike had access to the most sensitive core parts of the Windows operating system, the automated process caused an immediate global outage of computer systems using the Crowdstrike Falcon product, which is embedded in many computer systems at health care organizations. Rather than accept this event as inherent to a complex, digitized, and wired health care ecosystem, we urge the US Congress, health care regulators, and the public to insist on proactive preventive methods to avoid future IT catastrophic events rather than simply waiting for the next disruptive crisis requiring an emergent response.

International comparison of underlying disease among recipients of medical assistance in dyingJAMA Internal Medicine; Brandon Heidinger, BSc; Colleen Webber, PhD; Kenneth Chambaere, PhD; Eliana Close, PhD; Luc Deliens, PhD; Bregje Onwuteaka-Philipsen, PhD; Thaddeus Pope, JD, PhD; Agnes van der Heide, MD, PhD; Ben White, DPhil, LLB, (Hons); James Downar, MD, MHSc; 12/24In 2023, 282 million individuals lived in jurisdictions allowing medical assistance in dying (MAID). But regardless of jurisdiction, cancer and amyotrophic lateral sclerosis (ALS) consistently account for up to 80% of MAID cases, despite accounting for fewer than 30% of all deaths. This observation is consistent with the idea that MAID is driven heavily by illness-related factors common to people with those illnesses and inconsistent with the idea that MAID is driven substantially by factors that are external to the individual and that vary by jurisdiction, such as eligibility criteria, culture, social assistance, or palliative care service availability. The overall incidence of MAID increased over time (per 1 calendar year ... )