Literature Review

Doing the right thing for hospice patients Journal of Emergency Mediscal Services; by Abe Tolkoff, EMT, Daniel Tauber, NRP, and Amelia E. Breyre, MD, NRP; 5/2/24 Here is a novel solution in practice at the Yale New Haven Hospital Center for EMS; a paramedic hospice rotation. After being dispatched to a lift assist call, two novice EMTs proceeded to the address without lights or sirens. They grabbed their gear bag and walked up the stairs to the home. Knocking on the door, they announced “EMS!” and heard a frantic “Come in!” followed by, “he has a DNR.” ...

CIOs' top 15 priorities over next 3 years Becker's Health IT; by Giles Bruce; 5/1/24 CIOs' top priority over the next one to three years will be driving business innovation, according to a recent CIO survey. That differs from their current No. 1 focus, which is cybersecurity, per an April CIO story. Here are the activities CIOs plan to spend more time on in the next one to three years, according to the 2024 survey of 1,126 IT leaders: ... [click on the title's link for the list]. 

More legislation in Illinois deals with ending a person’s life The Center Square - Illinois; by Kevin Bessler; 5/1/24 Another bill has been introduced in Springfield dealing with end of life options for the terminally ill. Illinois state Sen. Julie Morrison’s Senate Bill 2644 would establish a statewide electronic registry that would contain Physician Orders for Life Sustaining Treatment (POLST) forms, which detail what type of medical treatment a critically ill patient does and does not want. “How much or how little treatment a person receives at the end of their life should be up to each individual instead of the one-size-fits-all approach,” said Morrison, D-Lake Forest, during a news conference Wednesday. “This measure will enable physicians to access forms detailing patients wishes in a single, accessible location.” 

Why health systems should embrace advanced in-home care models McKnights Home Care; by Marcy Carty, MD, MPH; 4/25/24Over the next two decades, the adult demographic over 50 years of age will increase by 25 million, and with over 75% expressing a strong desire to age in place, it’s imperative to champion care models that support safe, high-quality care within the home. Despite proactive care models to support aging in the home, acute needs still arise. Health systems stand to gain manifold by embracing the paradigm shift to care in the home. By moving more advanced care delivery into peoples’ homes, systems can effectively curb acute healthcare utilization, decreasing hospital-acquired conditions and drastically improving patient and family experience.

OSF launches new tools to help make end-of-life planning easier News25, Peoria, IL; by Liz Lape; 4/26/24 OSF Healthcare reports that thousands of patients are dying in medical facilities without end-of-life care plans. ... Sarah Overton, Chief Officer of Nursing, describes that studies show that over 70% of patients would prefer a setting other than a hospital to spend their last moments, like at home hospice or palliative care. OSF has launched self-service resources such as an Advanced Careplanning page and Patient Questionnaire on their app MyChart. Overton says the goal is to make end-of-life care planning more available to the public.

Hospice Claims Edits for Certifying PhysiciansCenters for Medicare & Medicaid Services (CMS); Related CR Release Date 4/18/24; Effective Date: 5/1/24; Implementation Date: 10/7/24Related CR Title: Additional Implementation Edits on Hospice Claims for Hospice Certifying Physician Medicare EnrollmentStarting May 1, 2024, we’ll deny hospice claims if the certifying physician, including hospice physician and hospice attending physician, isn’t on our PECOS hospice ordering and referring files. This addresses hospice program integrity and quality of care per Section 6405 of the Affordable Care Act.

FTC finalizes changes to data privacy rule to step up scrutiny of digital health apps Fierce Healthcare; by Heather Landi; 4/26/24 The Federal Trade Commission (FTC) finalized a rule Friday that aims to tighten the reins on digital health apps sharing consumers' sensitive medical data with tech companies. The agency issued a final version of its revised Health Breach Notification Rule to underscore the rule’s applicability to health apps in a bid to protect consumers' data privacy and provide more transparency about how companies collect their health information.

How Avow Hospice used triage to boost quality, reduce turnoverHospice News; by Jim Parker; 4/26/24Avow Hospice has implemented a triage system that has resulted in improved quality scores and reduced turnover. The Florida-based provider uses an acuity system that draws data from its electronic medical record (EMR) system to help stratify patients based on their most likely immediate needs. To complement these efforts, Avow also revamped its approach to night time and weekend visits, Rebecca Gatian, COO of Avow Hospice, said at the National Hospice and Palliative Care Organization’s Virtual Interdisciplinary Conference. 

How to overcome the disruptive forces that can impede high-value innovation Healthcare Financial Management Association (hfma.org); by Liz DeForest; 4/28/24 ... Healthcare is full of what we call “missing innovations” — good ideas that never go beyond promising pilot tests or, like EHRs, are adopted so slowly that their progress is measured in decades, even though other industries were adopting digital solutions very rapidly. Switchover disruptions are among the reasons for these missing innovations. ... [The author interviewed authors of Why not better and cheaper? (Oxford University Press, June 2023), written by industry analysts and twin brothers James B. and Robert S. Rebitzer about their observations of health system action and inaction. James Rebitzer is the Peter and Deborah Wexler Professor at Boston University’s Questrom School of Business. Robert Rebitzer is a national adviser at the consulting firm Manatt Health.]

Relief provisions not enough to mitigate damage of 80/20 policy, providers say McKnights Home Care; by Adam Healy; 4/24/24 Though newly finalized changes to the Medicaid Access Rule attempted to soften the blow of its controversial 80/20 provision, home care providers remained vehemently opposed to the Centers for Medicare & Medicaid Services’ strict new spending mandate. “Overall, while there are many positive provisions within the final rule as well as mitigations to make the payment adequacy provision less onerous, NAHC remains extremely concerned about the negative consequences of the pass-through policy,”  the National Association for Home Care & Hospice said in an analysis for NAHC members released after the rule was published. 

NAHC expresses disappointment regarding Medicaid Access Rule HomeCare; 4/23/24 The National Association for Home Care & Hospice (NAHC) released a statement noting that it was, 'extremely disappointed that the Centers for Medicare and Medicaid Services (CMS) elected to finalize the “payment adequacy” provision in the Medicaid Access Final Rule (CMS 2442-F).' "This is a misguided policy that will result in agency closures, force providers to exit the Medicaid program, and will ultimately make access issues worse around the country," a statement from the organization read. "As NAHC and our partners across the homecare industry have demonstrated, such a provision is not only unworkable due to the varied nature of Medicaid programs across the country, CMS also lacks statutory authority to impose this mandate."

Employing telehealth to ease the hospice transition for kids with cancer mHelathIntelligence, by Anuja Vaidya; 4/23/24 ... In a study published in the Journal of Pain and Symptom Management last month, Children's Healthcare of Atlanta researchers detailed a telehealth-based intervention the hospital has employed to ease the transition to hospice for young cancer patients and their families. ... The intervention includes a series of coordinated telehealth visits during the first month of hospice enrollment for children or young adults, 29 or younger, with cancer. ... Hospice nurses participating in the pilot received a tablet equipped with mobile WiFi cellular service that they would take to the family's home, which enabled the [hospital/pediatric specialty] nurses and families to join the call. ... The most important finding of the study was that coordinated telehealth visits between the hospital, hospice, and the families during the first month of hospice enrollment were feasible and acceptable to all participants.

Skepticism is healthy, but in medicine, it can be dangerous The New York Times, Guest Essay, by Dr. Daniela J. Lamas; 4/24/24 I arrived at the hospital one recent morning to find a team of doctors gathered just outside a patient room. The patient was struggling — his breaths too fast and too shallow. For days we had been trying to walk the line between treating the pain caused by his rapidly growing cancer and prolonging his life. [The author describes interactions with the family.] ... We are at a crossroads in medicine when it comes to public trust. After a pandemic that twisted science for political gain, it is not surprising that confidence in medicine is eroding. ... Our medical system relies on trust — in face-to-face meetings as well as public health bulletins. Distrust can lead doctors to burnout and can encourage avoidable negative outcomes for our patients.Editor's Note: For a patient/caregiver/family to agree to a hospice admission, they must first trust the physician who refers them to your organization. Before that, the referring physician must trust your organization. Too often, "trust" is diluted as a "soft skill." "Trust"--as described in this article--is a cornerstone, a foundation of strength, endurance, and integrity in the hardest, most conflicted times of decisions about living and dying that a person (and family) might face.