Literature Review

Hospitalists more likely to recommend hospice than specialists: Study Becker's Hospital Review, by Mariah Taylor; 3/27/24 A New Haven, CT-based Yale School of Medicine study [published in the American Cancer Society Journals] suggests oncology hospitalists have better hospice utilization and reduce hospital stays for cancer patients compared to oncologists. Researchers compared referrals for hospice settings from hospitalist-led services and oncologist-led services. Hospitalist-led services referred 11.8% of patients to inpatient hospice settings, nearly double the referral rate of oncologist-led services (5.8%). The adjusted average length of stay before inpatient hospice care was 6.83 days for hospitalist-led care and 16.29 days for oncologist-led care. 

The burden of getting medical care can exhaust older patients Navigating Aging, by Judith Graham; 3/27/24 [Ishani Ganguli] is the author of a new study showing that Medicare patients spend about three weeks a year having medical tests, visiting doctors, undergoing treatments or medical procedures, seeking care in emergency rooms, or spending time in the hospital or rehabilitation facilities. ... [Additionally,] more than 1 in 10 seniors, including those recovering from or managing serious illnesses, spent a much larger portion of their lives getting care — at least 50 days a year. ... When [treatment burden becomes overwhelming], people stop following medical advice and report having a poorer quality of life, the researchers found.

Why California doesn't know how many people are dying while homelessKQED, by Vanessa Rancano; 3/25/24 The grants manager and his team at Alameda County Health Care for the Homeless knew people were dying on the streets, but they wanted more than anecdotal evidence; they wanted data that could show them the big picture and help them hone their strategies. ... Alameda County’s latest homeless mortality report is now prompting the team to focus on how to extend palliative care services to unhoused people with terminal illnesses. Garlin estimates almost one-fifth of those who died in 2022 would likely have been eligible for hospice care.

Medicaid Health Plan will reimburse Health Equity Certification HealthPayerIntelligence, by Kelsey Waddill; 3/22/24 Meridian Health Plan of Illinois, Inc.—a wholly-owned subsidiary of Centene Corporation that offers Medicaid coverage—announced that it will cover part of the fee hospitals must pay to undergo health equity certification through the Joint Commission. ... The health plan’s goal in offering this aid is to support providers’ efforts to reduce local care disparities.

A $400M incentive drives hospitals to meet health equity goalsModern Healthcare, by Kara Hartnett; 3/21/24 Hospitals across Massachusetts are building infrastructure to examine health disparities and address social needs, driven by new incentives within the state's Medicaid program. The program is authorized to pay out $400 million annually to private acute-care hospitals, divided among those that comply with an evolving set of operational and quality standards related to health equity. Eventually, healthcare organizations will receive distributions based on their ability to close gaps in care.

HHS Secretary Becerra: We’re with you on telehealth flexibilities Hospice News, by Jim Parker; 3/21/24 Telehealth flexibilities must become permanent U.S. Health and Human Services (HHS) Secretary Xavier Becerra indicated in a congressional hearing [Wed]. At the end of this year, telehealth flexibilities implemented during the pandemic are slated to expire. In a hearing before the U.S. House Ways and Means Committee Becerra said that HHS was willing to make them permanent. However, he said this would require closer collaboration with state governments. “We’re with you. We can’t allow those flexibilities to expire, and we need to work closer with our state partners, because much of the flexibility that comes from telehealth means being able to go over state lines,” Becerra said.

5 myths about dying that too many people believeThe Hearty Soul, by Maria Sykes; 3/21/24 Myth# 1: I should always stay positive for the sake of my loved one.Myth #2: I should make sure my loved one eats, drinks, and sleeps as normal.Myth #3: I need to prolong my loved one's life as much as possible.Myth #4: It's important to limit the use of painkillers to keep my loved one healthy.Myth #5: If I seek help to care for my loved one, I'm a failure. 

Home-based care employment exceeding pre-pandemic levels Hospice News, by Jim Parker; 3/19/24 Employment in the home-based care sector rose above pre-pandemic levels in 2023, according to the Medicare Payment Advisory Commission (MedPAC). The U.S. Department of Commerce defines this sector to include hospices, home health agencies, private duty, pediatric agencies and other providers of care in the home. ... Nevertheless, workforce pressures and associated costs are overwhelmingly the industry’s most damaging headwind, including the associated wage hikes, enhanced benefits and bonus programs. The shortages also have reduced clinical capacity, which has contributed to drops in patient census and length of stay for many providers.

Medicare Advantage prior authorization: The impact - increased access to care HHS-OIG; 3/19/24 HHS-OIG’s work on this issue drew national attention to the problem spurring the Centers for Medicare & Medicaid Services, the Industry, and Congress to action.  Editor's Note: You can download the "Impact Brief" from this site. Click on the title's link.

Use of machine learning to optimize referral for early palliative care: Are prognostic predictions enough  Journal of Clinical Oncology - Editorials; by Gary E. Weissman, MD, MSHP; Joseph A. Greer, PhD; and Jennifer S. Temel, MD; 3/15/24  The Takeaway In the article that accompanies this editorial, [Weissman] et al used a machine learning (ML) algorithm to identify patients with advanced cancer who were receiving non–curative-intent treatment and at risk of death within 1 year to allocate early palliative care services at least 6 months before death as a means to increase use of early palliative care in the context of limited resources. While ML prognostic models are one promising strategy for triaging palliative care services, initiation of palliative care based exclusively on estimated survival and in the months before death likely excludes patients who would benefit from early palliative care initiated at the time of diagnosis, regardless of their estimated survival.

Institutional effforts to address legacies of slavery—Implications for the health care system JAMA Health Forum; by Sara N. Bleich, PhD; Jose F. Figueroa, MD, MPH; Martha Minow, JD; 3/14/24... Health care systems across the country are increasing their efforts to help address structural racism. For example, the Healthcare Anchor Network (HAN), which launched in 2017, includes 40 health systems in 45 states and Washington, DC, that have committed to address structural racism and the corresponding public health disparities. HAN aims to improve community health by leveraging key assets such as hiring, purchasing, and place-based investment strategies.

Palliative and end-of-life care in hematologic malignancies: Progress and opportunities JCO Oncology Practice, by Mazie Tsang, MD, MAS, MS and Thomas W. LeBlanc, MD, MA, MHS, FAAHPM, FASC; 3/13/24 ... An important finding from this study was the qualitative data from narratives of volunteer caregivers and hospice staff that described daily patient care, changes in patient status, perceived symptom burden, and indications for medication administration. The authors identified skin integrity concerns, bleeding, pathologic fractures, and delirium as unique issues for patients with hematologic malignancies enrolled on hospice. ... These findings provide further evidence that hospice care can and does work well for some patients with hematologic malignancies. 

Film Festival and local organizations partner to present ‘Lily’ March 21 Sedona.Biz; 3/9/24Accord Hospice & Palliative Care is continuing their educational efforts by partnering with the Hospice Foundation of America (HFA) to marry theater and Advance Care Directive education through the AD Project – a series of 10-minute plays that feature different relationships and settings to illustrate the importance of putting your medical wishes in writing. ...Playwright Bryan Harnetiaux has worked with HFA for years developing a series of shows that depict real life scenarios involving all different family dynamics. The show “Lily” will present a divorced couple who are embarking on a very real dilemma – who to choose to be your voice when you can no longer speak for yourself.