Literature Review

NAHC, NHPCO comment on revision of Hospice Certifying Physician Enrollment RequirementHomeCare; 6/7/24 The National Association for Home Care & Hospice (NAHC) and the National Hospice and Palliative Care Organization (NHPCO) responded to the Centers for Medicare & Medicaid Services (CMS) recently revised guidance regarding the implementation of the hospice certifying physician enrollment requirement. NAHC and NHPCO identified that some instruction provided by CMS was inconsistent with established law and regulations regarding the certification of a patient’s terminal illness for new hospice elections after the first benefit period. That instruction, if implemented, could have resulted in major negative impacts on hospices and the patients and families they serve. Both organizations requested that CMS retract the guidance to remain consistent with regulation and statute. On June 6, CMS rescinded its guidance in order to align with current regulations, offering clarity for providers. 

The role and professional standards of the Adult-Gerontology Nurse Practitioner in hospice and palliative careJournal of Hospice and Palliative Nursing; by Heather Coats, PhD, APRN-BC, Kelly Henrichs, Kelly DNP, RN, GNP-BC; 6/24The adult/gerontology (gero) nurse practitioner (NP) delivers primary and/or specialty palliative care to persons and their families who live each day with a myriad of serious illnesses. In this role, the adult/gero NP uses their skill set to address the whole person (physical, psychological, social, and spiritual/existential) to improve the quality of life for persons they care for. This article is the fourth in a series of 6 highlighting the different roles of the adult/gero NP and the advanced certified hospice and palliative registered nurse, and how these 2 roles overlap. The purpose of this article was to provide details of education and certification pathways for these NP roles, describe the overlaps in clinical care, and illustrate how the adult/gero NP in palliative and hospice care can contribute to leadership in program development for care of persons and their families who live with serious illness.

Hospice Certifying Physician edit in effectAAPC - American Academy of Professional Coders; by Rebecca Johnson; 6/3/24 The Centers for Medicare & Medicaid Services (CMS) and its Home Health and Hospice (HHH) Medicare Administrative Contractors (MACs) are all systems go for the new — and potentially troublesome — claims system edit. The edit went into effect June 3. ... In the 2024 Hospice Payment Rate Update final rule, CMS adopted a requirement that two categories of physicians must be enrolled in or validly opted out of Medicare for hospice services to be paid: the hospice medical director or the physician member of the hospice interdisciplinary group; and the attending physician that certifies the patient for hospice. CMS did at least grant hospices’ requests for an implementation delay at that time, moving the deadline from the proposed Oct. 1, 2023, to May 1, 2024. Then, on the eve of that start date, CMS bumped the edit for one more month. ...

Improving nursing home care goes beyond helping nursesMcKnight's Long-Term Care News; by Kristen Fischer; 5/30/24An editorial published Monday in the Journal of the American Geriatrics Society [Quality of care for older adults in nursing homes: It begins with registered nurses but does not end there!] points out flaws in moves to improve nursing home care outlined in a report published in March. Authors of the March report [RNs in nursing homes—It is not always about the numbers] shared a method to move beyond staffing numbers and optimize the workload of registered nurses. The model detailed nurse accountability, decision making, continuity of information and continuity of care. The authors shared the differences between RN work in the nursing home compared with acute care hospitals, and they also emphasized the importance of geriatric nursing knowledge.

Hospice patient in Red Wing died after being given morphine by mistakeBring Me the News (MN); by Tommy Wiita; 5/29/24A hospice patient at a Red Wing assisted living facility suffering a diabetic emergency died after being given morphine by mistake. A Minnesota Department of Health State Rapid Response Investigative Report found that the allegation of neglect against the Mayo Clinic Hospice at 906 College Way was substantiated as the staff member "failed to provide timely care, monitoring, and safe medication administration services. The report says the staff member provided five times the resident's prescribed dose of morphine "in error" and didn't provide interventions when the resident was having a seizure and had a critically low blood sugar of 29.

Over 400 physicians from Delaware’s ChristianaCare move to unionize Portside; by Jennifer Henderson / MedPageToday; 5/28/24 More than 400 physicians from Delaware's Christiana Hospital, Wilmington Hospital, and Middletown Free-standing Emergency Department -- all part of the ChristianaCare health system -- filed to unionize with Doctors Council SEIU Local 10MD. "If successful, this will be the first physician union in Delaware and the first union of any kind at ChristianaCare," Doctors Council SEIU said in an announcement of the filing, which pointed to the ongoing corporatization of medicine as driving the physicians' efforts. Some of the specific concerns that physicians detailed in regard to their filing included understaffing and inadequate resources, corporate influence on medical decision making, limited input in matters affecting patient care and physician safety and autonomy, and moral injury caused by pressure to place profit over patients. Editor's Note: These "specific concerns" reflect consistent themes with other, recent healthcare unionization and strikes throughout the nation, within the scope of one's practice (e.g., physicians vs. nurses). 

Bereavement care, often an ‘afterthought,’ should be public health priority Healio; by Jennifer Byrne; 5/26/24 Health care institutions and their staffs must take action to ensure bereavement care shifts from “an afterthought to a public health priority,” according to a position paper published in The Lancet Public Health. Bereavement support often is considered part of palliative care; however, there often is a lack of continuity of care for bereaved individuals after a person dies in palliative or end-of-life care settings, the paper’s authors contend. Healio spoke with [co-author Wendy G. Lichtenthal,PhD] about what bereavement care encompasses, why it should be prioritized and how institutions can support grieving individuals who may require assistance.

Nurse charged with stealing pills while taking care of hospice patient Fox56; by Emily Cherkauskas; 5/22/24Pennsylvania State Police say a registered nurse stole hundreds of prescription pills while taking care of a hospice patient. According to Pennsylvania State Police, on Feb. 12, troopers were contacted by the director of operations at the Amedisys Home Health / Hospice Care. Troopers were told that Registered Nurse Ashley Laura Miller, 36, of Mohrsville, had become a suspect in the theft and diversion of Oxycodone and Ativan prescriptions. ... [Upon] the passing of the patient, an additional nurse noted that 200 Oxycodone and 30 Ativan pills were missing from the narcotics count. ... On Wednesday, May 22, Miller was arraigned with bail set at $5000.

Life support decisions are usually made within 72 hours. Is that too soon? Advisory Board; by Daily Briefing; 5/21/24After a patient suffers a traumatic brain injury (TBI) and is on a ventilator, when is the right time to withdraw life support? A new study published in the Journal of Neurotrauma suggests that doctors and patient family members should wait a bit longer than usual. ... The researchers found that the majority of patients whose life support wasn't withdrawn ended up dying in the hospital anyways within about six days. However, 42% of patients who continued life support recovered enough within the following year to have some level of independence, and a few even returned to their former lives.

The human side of AI: Insights on balancing automation and empathy Innovation & Tech Today; by Enrico Palmerino; 5/20/24 ... As AI automates more tasks with clinical precision, empathy is a critical human element we cannot overlook. That intangible ability to understand and share the feelings of another isn’t just a soft skill — it’s an essential catalyst for trust, loyalty, and genuine connection. Consider the healthcare industry, where empathy is (quite literally) often a matter of life and death. Can an AI-powered diagnostic system truly grasp a patient’s fear and vulnerability when facing a serious illness? ... Finding the delicate balance between leveraging AI automation and preserving human empathy is the new challenge before us. It’s a duality that will shape how businesses operate and how we interact with technology. ... Let the machines optimize processes while we optimize the ability to connect and inspire. In this harmonious future, AI is a tool that elevates us — not replaces us.Editor's Note: Is AI a hot topic among your leaders and interdisciplinary clinicians? Often, "empathy" and "communication" are cited as key cautions and conflicts. 

When doctors withhold futile treatments, that isn’t ‘assisted dying’ The Guardian; by Dr. James Haslam; 5/15/24 [Commentary / Letter] I write in response to Dr Jagat Aulakh’s letter (A form of assisted dying already happens in hospitals, 8 May). It must be made clear that withholding or withdrawing futile treatments is not and never has been assisted dying. Stopping – or not starting – treatments that are not wanted, are not working or are not worthwhile is good medicine and the law of the land. Whereas “assisted dying” is the modern euphemism for physician-assisted suicide and euthanasia, both forms of medicalised killing [the author's choice of words]. ... Intentions are important. ...Editor's Note: This thoughtful response puts forth ethical support against Medical Aid in Dying (MAiD), also known as "physican assisted suicide." Likely, different opinions can be inflammatory among your hospice and palliative employees, board, community, and more personally among your family and friends. As hospice and palliative leaders, we must address this issue with respectful dialogue, critical thinking, case studies, personal beliefs and values, empathy, and humanity.

Emerging leaders in hospice and palliative care AAHPM - American Academy of Hospice and Palliative Medicine; webpage source for various press releeases of individuals; 5/24AAHPM developed the Emerging Leaders in Hospice and Palliative Care program to recognize the exceptional work accomplished by the next generation of leaders and bring increased exposure to the specialty of hospice and palliative medicine. In 2014, the first class of Emerging Leaders was named. AAHPM seeks to recognize accomplished early career professionals and the next generation of hospice and palliative care leaders. This award recognizes new Emerging Leaders in recognition of their career accomplishments, involvement in the Academy, mentoring of residents and students, and participation in charitable work. [Click on the title's link for the list of 36 honorees.]Editor's Note: Do you work with or know any of these honorees? If so, please share this with them and your colleagues, along with congratulations from Hospice & Palliative Care Today! (Invite them to register for free--no strings attached--to our daily newsletter.)