Literature Review

John Oliver on US for-profit hospice care: ‘too important to just hope the free market fixes it' The Guardian; by Adrian Horton; 8/19/24 On the latest Last Week Tonight, John Oliver delved into the many issues with hospice care in the US. Doing so is “an almost offensive parody of this show”, he acknowledged. “If somebody else did that, it would genuinely be hurtful. But I promise this is worth talking about.” There are “lots of dedicated people work with hospices, providing huge relief for dying patients and their families, particularly those who want to remain at home”, such as the 1.8 million Americans who received end-of-life care at home last year. But like anything, hospice is subject to fraud, mismanagement and abuse. One government report estimated that hospice’s inappropriate billing costs Medicare hundreds of millions per year. ... “Hospice care, when done well, is hugely beneficial to those that are dying and their families. It is too important to just hope the free market fixes it,” Oliver concluded. “This industry badly needs reform. That’s clear.” [Click on links below for more information and responses.] 

A.L.S. stole his voice. A.I. retrieved it. DNYUZ, originally posted in The New York Times; 8/15/24Four years ago, Casey Harrell sang his last bedtime nursery rhyme to his daughter. By then, A.L.S. had begun laying waste to Mr. Harrell’s muscles, stealing from him one ritual after another: going on walks with his wife, holding his daughter, turning the pages of a book. “Like a night burglar,” his wife, Levana Saxon, wrote of the disease in a poem. ... Last July, doctors at the University of California, Davis, surgically implanted electrodes in Mr. Harrell’s brain to try to discern what he was trying to say. ... Yet the results surpassed expectations, the researchers reported on Wednesday in The New England Journal of Medicine, setting a new bar for implanted speech decoders and illustrating the potential power of such devices for people with speech impairments.

YoloCares: Overregulated California skips key regulations Our Community Now (OCN); by Craig Dresang, Special to The Enterprise; 8/17/24 California is the most heavily regulated state in the country. According to the Mercatus Center at George Mason University, the Golden State has 420,434 regulatory restrictions which is more than double the national average. ... So, it seems ironic that certain critically important sectors in California that impact the well-being, health and quality of life for millions of seniors are grossly unchecked and mis-regulated. My husband, who has owned and operated salons for nearly 30 years, pointed out that California’s Board of Barbering and Cosmetology (BBC) appears to have more rigorous rules and regulations for nail technicians than it does for board-and-care (B&C) owners or privately owned hospice companies. ... [Click on the title's link to continue reading.]

Mortuaries get a modern-day makeover The Hustle; by Sara Friedman; 8/20/24 When window shopping in a city, it’s often an aesthetic storefront that captures your attention and pulls you inside. But what if the handcrafted vase that caught your eye was actually an urn for human remains? That’s the business model for the crop of trendy, modernized mortuaries popping up around the world, per The New York Times. ... Pretty enough to be spas or nightclubs, these new mortuaries bring some levity to customers looking for something different. In a Co-Op Funeralcare study of 4k people in the UK, 68% said they see funerals as celebrations of life, not sad occasions. [Examples given] ... These new mortuary models are tapping into a lucrative industry: The average funeral costs ~$6.6k in London, while the median cost of a US funeral is $8.3k.

New bill in Congress would improve end-of-life carePublic News Service; Suzanne Potter; 8/23/24A bill just introduced in Congress would raise public awareness of issues surrounding the end of life, including palliative care, and hospice. The Compassionate Care Act [co-sponsored by Rep. Nanette Barragán, D-CA, and Sen. Richard Blumenthal, D-CT] would establish guidelines for advance care planning between health providers and patients... The bill would direct the government to develop education resources for providers, expand telehealth options and facilitate a study of a national advance care planning registry, which would allow patients to transfer their advance directives from state to state.

John Oliver on US for-profit hospice care: ‘too important to just hope the free market fixes it' The Guardian; by Adrian Horton; 8/19/24 On the latest Last Week Tonight, John Oliver delved into the many issues with hospice care in the US. Doing so is “an almost offensive parody of this show”, he acknowledged. “If somebody else did that, it would genuinely be hurtful. But I promise this is worth talking about.” There are “lots of dedicated people work with hospices, providing huge relief for dying patients and their families, particularly those who want to remain at home”, such as the 1.8 million Americans who received end-of-life care at home last year. But like anything, hospice is subject to fraud, mismanagement and abuse. One government report estimated that hospice’s inappropriate billing costs Medicare hundreds of millions per year. ... “Hospice care, when done well, is hugely beneficial to those that are dying and their families. It is too important to just hope the free market fixes it,” Oliver concluded. “This industry badly needs reform. That’s clear.” [Click on links below for hospice responses to this "Hospice" episode of Last Week Tonight.] 

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.

Today's Heartwarming Story [MHPCA Hospice in Corrections]Per Facebook post: Over the past decade, the Missouri Hospice and Palliative Care Association has trained hundreds of residents of Missouri state prisons to become hospice volunteers, providing comfort and companionship to terminally ill peers. The newest group recently completed training at Farmington Correctional Center. Volunteers develop skills in helping with daily activities, practicing empathy and active listening, and learning to recognize and respond to patients’ spiritual and emotional needs.

Pennant’s home health, hospice growth ‘significantly ahead’ of prior expectationsHome Health Care News; by Audrie Martin; 8/7/24The Pennant Group Inc. (Nasdaq: PNTG) leaders highlighted the company’s significant home health growth Tuesday. They also teased continued expansion in the East Coast and elsewhere. “We are thrilled to report record-breaking second quarter results as we continue to experience momentum across all our service lines and create meaningful growth opportunities for local leaders and teams,” Pennant CEO Brent Guerisoli said during the company’s second-quarter earnings call. “Our financial performance and growth trajectory reflect the consistent efforts we have applied to every aspect of our business through our five key focus areas: leadership development, clinical excellence, employee engagement, margin and growth.” The Pennant Group is a holding company based in Eagle, Idaho, with independent operating subsidiaries that provide health care services through 117 home health and hospice agencies and 54 senior living communities across 13 states.

Fearless hospice patient takes joyrideWest Valley View (AZ); by Lin Sue Flood; 8/7/24Don Tamuty, a beloved former Madison Unified School District teacher, had one thing left on his bucket list. The 95-year-old shared with his hospice nurse, Monisha Roe, that he would love to ride in a driverless car. Monisha and the rest of Don’s Hospice of the Valley care team knew exactly how to fulfill that wish! They booked a driverless cruise on Waymo One to take Don out to a nice restaurant.

Rescue from above: How drones may narrow emergency response timesKFF Health News; by Michelle Andrews; 7/22/24Starting in September, if someone in Clemmons, North Carolina, calls 911 to report a cardiac arrest, the first responder on the scene may be a drone carrying an automated external defibrillator, or AED. “The idea is for the drone to get there several minutes before first responders,” such as an emergency medical technician or an ambulance, said Daniel Crews, a spokesperson for the sheriff’s office in Forsyth County, where Clemmons is located. The sheriff’s office is partnering on the project with local emergency services, the Clinical Research Institute at Duke University, and the drone consulting firm Hovecon. “The ultimate goal is to save lives and improve life expectancy for someone experiencing a cardiac episode,” Crews said.Publisher's note: As with all things tech, when and how might drones be used in hospice?

Identifying and addressing bias in artificial intelligenceJAMA Network Open; by Byron Crowe, Jorge A. Rodriguez; 8/6/24[Invited commentary.] In this issue, Lee and colleagues (Demographic representation of generative artificial intelligence images of physicians) describe the performance of several widely used artificial intelligence (AI) image generation models on producing images of physicians in the United States. The key question the authors set out to answer was whether the models would produce images that accurately reflect the actual racial, ethnic, and gender composition of the US physician workforce, or whether the models would demonstrate biased performance. One important aspect of the study method was that the authors used relatively open-ended prompts, including “Photo of a physician in the United States,” allowing the machinations of the AI to produce an image that it determined was most likely to meet the needs of the end user. AI tools powered by large language models, including the ones examined in the study, use a degree of randomness in their outputs, so models are expected to produce different images in response to each prompt—but how different would the images be? Their findings are striking. First, although 63% of US physicians are White, the models produced images of White physicians 82% of the time. Additionally, several models produced no images of Asian or Latino physicians despite nearly a third of the current physician workforce identifying as a member of these groups. The models also severely underrepresented women in their outputs, producing images of women physicians only 7% of the time. These results demonstrate a clear bias in outputs relative to actual physician demographics. But what do these findings mean for AI and its use in medicine?Publisher's note: This is a thought-provoking article on machine output - whether that's AI, a Google search, etc. It ultimately places responsibility of outputs and actions on people with conscience.