Literature Review

Challenges in health care for persons with multiple chronic conditions—where to go and how to get there?JAMA Open Network; Gregory M. Ouellet, MD, MHS; Jennifer A. Ouellet, MD, MHPE; Mary E. Tinetti, MD; 10/24Approximately 75% of older adults, and more than one-third of all adults receiving health care, have MCC [multiple chronic conditions]. As has been well reported, siloed, disease-based health care for persons with MCC may be burdensome, fragmented, of uncertain benefit and potential harm, and not aligned with individuals’ health priorities (ie, what matters most to them about their health and health care). The result of all this is the imposition of unwanted and unhelpful care, neglect of potentially helpful interventions that do not fall under the narrow confines of disease-based care, and inattention to what matters to each person. Finally, quality and payment metrics focused on what matters to the individual will both encourage, and result from, a push to whole-person care.

Pennsylvania signs home care, hospice efficiency bills into law McKnights Home Care; by Adam Healy; 11/5/24 Pennsylvania Gov. Josh Shapiro (D) signed into law two bills that will reduce operational challenges and improve recruitment efforts for home care and hospice agencies. House Bill 155 allows healthcare providers, including home care and hospice agencies, to use remote video technology for interviews with direct care workers. Meanwhile, Senate Bill 1080 allows licensed practical nurses (LPNs) to pronounce death in home-based hospice settings. These two new laws will make direct care worker recruiting processes more accessible and efficient, while improving end-of-life care for both patients and providers, according to the Pennsylvania Homecare Association. “The signing into law of HB 155 and SB 1080 helps create efficiencies in how we deliver home-based care,” Mia Haney, chief executive officer of PHA, said Friday in a statement. “With a growing demand for these services, efforts such as these allow providers to use their time effectively and focus on what’s most important — quality of care.”

Terminally ill patients from other states can’t come to N.J. to end their lives, court rules NJ.com; by Chris Sheldon; 10/29/24 A federal judge ruled Wednesday that the residency requirement in New Jersey’s medical aid in dying law does not violate the U.S. Constitution, meaning the state can continue to keep its right to die law exclusively for residents. The ruling was in response to a lawsuit filed in August 2023 by Compassion & Choices on behalf of terminally-ill cancer patients in Delaware and Pennsylvania and two New Jersey doctors, according to a statement from the non-profit, which works to expand choice for the end of life.

Court rules False Claims Act Provisions unconstitutional, with implications for hospice cases Hospice News; by Jim Parker; 10/7/24 A federal judge has struck down the whistleblower provisions of the False Claims Act, with broad implications for hospice and other health care enforcement actions. The ruling centers on the law’s qui tam clauses, which the court found unconstitutional. In a qui tam action, a whistleblower, called a “relator” by the courts, files a False Claims Act suit on behalf of the government and possibly receives a portion of any funds recovered by the government via the lawsuit, typically ranging from 15% to 25%. The overwhelming majority of False Claims Act cases involve qui tam whistleblowers. In Fiscal Year 2023, for example, these cases recovered $2.3 billion of the total $2.68 billion recouped by the government in FCA settlements and judgements, according to a report from the law firm Polsinelli. ... FCA cases have been rampant in the hospice space during the last several years. Many of the major cases and settlements that have occurred during that time have been qui tam actions, including two major actions this year. ...

EEOC sues AccentCare Home Health Care company for pay discrimination and retaliation U.S. Equal Employment Opportunity Commission; Press Release; 9/27/24 AccentCare, a nationwide home health care service company headquartered in Dallas, Texas, violated federal civil rights laws by paying female employees less than a male colleague because of their sex and retaliating against a female employee who repeatedly complained, the U.S. Equal Employment Opportunity Commission (EEOC) charged in a lawsuit filed today. According to the EEOC’s lawsuit, female Licensed Practical Nurses (LPNs) working out of AccentCare’s Pottsville, Pennsylvania, location were paid less than their male colleague for performing equal work, despite their superior qualifications. After a female LPN repeatedly complained about the gender-based pay disparity and requested a raise, AccentCare retaliated against her, and ultimately fired her. Such alleged conduct violates Title VII of the Civil Rights Act of 1964 and the Equal Pay Act of 1963, which prohibits pay discrimination based on sex and retaliation for opposing sex discrimination.

You cannot come to New Jersey to die, judge says New Jersey 101.5; by Eric Scott; 9/20/24 Terminally ill individuals may not travel to New Jersey to end their lives. When New Jersey's Aid in Dying law took effect in 2019, it included a provision that doctors verify a patient's residency before prescribing them medications that will end their lives. A federal judge has ruled the residency requirement does not violate the U.S. Constitution. The ruling came after terminally ill cancer patients from Delaware and Pennsylvania sued. They wanted to travel to New Jersey to end their lives. ...

Vaccine mandates for health care workers—An effective policy tool for past and future pandemics JAMA Open Network; John B. Lynch, MD, MPH; 8/24COVID-19 vaccines reduce the risk of infection, severe disease, long COVID, and death. Although COVID-19 vaccines were free and obtainable in 2021 and as early as December 2020 for some health care workers (HCWs), a considerable proportion of people in the US chose not to get vaccinated. Wang and colleagues investigated this challenging and critically important question: do public policies that required health care workers to get vaccinated increase vaccine uptake? ... by the second week after a mandate was implemented, Wang et al found an increase in the proportion of HCWs ever vaccinated or who had completed or intended to complete the primary vaccination series. These results join those of other studies that found an association between vaccine mandates and increased vaccinations in specific populations. Studies like that by Wang et al provide more information that could be used to design mandates and communicate the impact of future mandates, providing much needed and better measures of the perceived tradeoffs of governmental action in preparation for the next pandemic and in the prevention of nonpandemic infectious diseases.

[NJ] Governor Murphy signs "Louisa Carman Medical Debt Relief Act” Official Site of the State of New Jersey; 7/22/24 Governor Phil Murphy today signed the Louisa Carman Medical Debt Relief Act which will help New Jersey families avoid falling into medical debt and protect individuals from predatory medical debt collectors. The Louisa Carman Medical Debt Relief Act is named in honor of a member of the Governor’s Office who helped craft the proposal before tragically passing away in a car accident on New Year’s Day at the age of 25. Joined by Louisa’s family and advocates, the Governor signed the bill, advancing his Administration’s efforts to make New Jersey’s health care system more accessible and more affordable for more people.

County Commissioners question providing nonprofits with funding Times Union Online, Kosciusko County, IN; by David L. Slone; 7/16/24 The future of Kosciusko County government providing funding to local nonprofit organizations is uncertain. Tuesday, after some discussion on the appropriateness of the county giving taxpayer dollars to nonprofits, the Kosciusko County Commissioners approved recommending to the County Council that seven nonprofits receive the same amount of funds in 2025 as they did in 2024. [Among the organizations listed is] Stillwater Hospice, $50,000. ... [Commissioner Cary] Groninger said the county council would have the final say on the nonprofit funding. ... [Commissioner Brad] Jackson said the decision was a tough one and they didn’t just want to stop providing funding without giving the nonprofits notice. 

The Physician-Focused Payment Model Technical Advisory Committee (PTAC) listening session 2: Complex chronic conditions [including Ira Byock, MD, FAAHPM, and Betty Ferrell, RN, PhD]Press release; 7/4/24PTAC held a 2-day meeting on Addressing the Needs of Patients with Complex Chronic Conditions or Serious Illnesses in Population-Based Total Cost of Care (PB_TOC) Models. [Presentations include Ira Byock, MD, FAAHPM: Patient perspectives & doctors' roles in caring well through the end of life (timestamp 33:53) and Betty Ferrell, RN, PhD: Optimizing the mix of palliative care and end-of-life care in PB-TCOC Models (timestamp 48:32).]

Optum to pay $20M to settle improper prescription allegations Becker's Hospital Review; by Rylee Wilson; 6/28/24 OptumRx will pay $20 million to settle allegations it improperly dispensed some opioid medications, the Justice Department said June 27. The settlement resolves an investigation into if OptumRx improperly filled certain opioid prescriptions between 2013 and 2015. The Justice Department alleged the pharmaceutical benefit manager improperly dispensed opioids in combination with other drugs, including benzodiazepines and muscle relaxants, from its mail-order pharmacy operations in Carlsbad, Calif. Opioids prescribed alongside benzodiazepines and muscle relaxants are commonly referred to as "trinity" prescriptions. These prescriptions raise red flags that the drugs may not be for legitimate medical use, and could lead to the diversion of controlled substances, the Justice Department said. In its investigation, the department alleged OptumRx dispensed trinity prescriptions without resolving red flags. OptumRx does not admit liability as part of the settlement.

Spread of assisted dying shines spotlight on difficult decisions Financial Times; by Charlotte Middlehurst; 5/22/24 The right to control your death is a principle that societies have debated for centuries. But, as more countries prepare to legalise medically-assisted dying, the reality of allowing the practice is sparking fresh ethical arguments. Some form of assisted dying is now legal in 9 countries, as well as in 11 US states and parts of Australia. [Click on the title's link for data and discussion regarding international policies; concerns about increased "unassisted suicide"; rapid legislative/medical decisions; inducing death; devaluing the lives of disabled persons; ethical choices based on economic factors; doctors' choices; and more.] 

Connecticut hospices obtain carveout from sweeping safety billMcKnight's Home Care; by Adam Healy; 5/15/24Grassroots advocacy paid off for Connecticut’s hospice providers. Last week, they successfully obtained a carveout from Senate Bill 1, which requires home-based healthcare providers to run background checks on all potential clients. “It was basically a total victory,” Barbara Pearce, chief executive officer of The Connecticut Hospice and the main proponent calling for a carveout, told McKnight’s Home Care Daily Pulse. “You’re never going to defeat Senate Bill One, because they said - in naming it - it’s their top priority. We just tried to take hospice off, and we did.” ... The bill would have unintentionally limited patients’ access to hospice care, Pearce said. By the time a background check could be conducted on a client, it may be too late to provide effective care for the patient. Furthermore, current staffing challenges hospices face would make compliance even harder, she noted.