Literature Review

Communication gaps among clinicians may limit conversations about prognosis, hospice Healio - HemOncToday; by Jennifer Byrne; 10/16/24 Clinicians in acute or post-acute care settings may delay or avoid serious illness conversations with patients whose cancer prognoses are worsening out of deference to the patient’s oncologist, according to study findings. Researchers conducted 37 semi-structured interviews with physicians and leaders in hospital medicine, oncology, palliative care, home health care and hospice. Investigators coded and analyzed the interviews using thematic content analysis. Evaluation of the responses yielded insights into how care silos, lack of clear clinical roles and other factors may affect communication between oncologists and other clinicians. ... "We know that the 3-month window after an older adult with cancer is discharged to a skilled nursing facility can be comprised of complex medical decision making and changing preferences of care. Lack of appropriate serious illness communication during this time can result in unwanted hospitalizations and unwanted, aggressive care at the end of life."

Dozens of CarePartners patients in Asheville transferred to other facilities after HCA temporarily shuts down rehab, hospice center Asheville Watchdog; by Andrew R. Jones; 10/14/24 Hundreds of employees uncertain about their jobs after facility is closed to ease pressure on Mission Hospital. Mission Health’s CarePartners Health Services is temporarily closed following the pressures Hurricane Helene put on Asheville’s health care system, disrupting rehabilitative care for more than 50 patients and forcing more than 250 employees to take temporary jobs elsewhere in the system, according to employees and internal emails obtained by Asheville Watchdog.  ... The closing affected nearly 50 inpatient rehab patients, several long-term acute care patients, and eight hospice patients, all of whom were sent to home caregivers, skilled nursing facilities, other inpatient rehab programs, and UNC Health Caldwell in Lenoir, more than an hour’s drive to the east, according to one employee.

2,400 Kaiser mental health workers to begin open-ended strike: 6 things to know Becker's Hospital Review; by Kelly Gooch; 10/11/24 Members of the National Union of Healthcare Workers are set to begin an open-ended strike Oct. 21 at Kaiser Permanente locations in Southern California. Six things to know:

Home health providers, CMS raise red flags over delayed access Modern Healthcare; by Diane Eastabrook; 10/11/24 Delayed home health access for Medicare beneficiaries is increasingly raising alarms from the Centers for Medicare and Medicaid Services and the home health industry as providers place blame on staff shortages and the program's reimbursement rates. More than a third of Medicare fee-for-service beneficiaries referred to home health following hospitalizations did not receive services within seven days of discharge, according to an analysis of 2023 Medicare claims from healthcare analytics company CareJourney. The report echoes a similar study published by the Commonwealth Fund in July, as well as concerns CMS raised about access in its proposed 2025 home health pay rule. ... Years of low Medicare reimbursements are taking a toll on the home health companies trade groups represent, said William Dombi, president emeritus of the National Association of Home Care and Hospice, which is part of the National Alliance for Care at Home, and Cunningham.

5 cornerstones of hospitals' hurricane emergency planning Becker's Hospital Review; by Stefanie Asin; 10/9/24 As the number of natural disasters grows in the U.S. and in the world, so must the readiness of hospitals and other healthcare facilities. In 2023, the U.S. saw 28 billion-dollar natural disasters, surpassing the 2020 total. Worldwide, there was a fivefold increase in the number of weather-related disasters in the last 50 years. Healthcare facilities must be diligent and prepared as the incidents of natural disasters are not expected to slow down. In fact, they are predicted to get worse. Recent events have underscored this necessity. ... [Click on the title's link to continue reading.]  

Implementation and outcomes of a dementia-friendly training program in five hospitalsGeriatric Nursing; Ellen Roberts, Ellen C Schneider, Maureen Dale, Cristine B Henage, Casey J Kelley, Jan Busby-Whitehead; 10/24Hospitalized patients living with dementia (PLWD) age 65+ generally experience poor outcomes. This study's purpose was to implement dementia-friendly training with staff, track patient outcomes, and implement sustainable system changes. Positive changes in staff ratings from pre- to post- intervention were observed. Number of falls and readmissions did not change. The average number of stays per patient decreased ... Conclusions: Dementia-friendly hospital training is effective in improving staff recognition of the symptoms and needs of PLWD, and responding appropriately.

Maryland hospitals face IV shortage as hurricanes hit suppliers The Baltimore Banner; by Sapna Bansil; 10/10/24 Hospitals across Maryland are scrambling to conserve IV fluids after damage from Hurricane Helene last month halted production at the country’s leading manufacturer and triggered a national shortage — which could worsen as Hurricane Milton drenches Florida this week. Baxter International shut down its plant in Marion, N.C., about 35 miles east of Asheville, after it experienced severe flooding and a nearby bridge collapsed. The facility produced 1.5 million bags a day and accounted for 60% of the nation’s supply of IV fluids, according to the American Hospital Association. Another key manufacturing plant, for B. Braun Medical in Daytona Beach, Florida, is in the path of Hurricane Milton. The company said that it planned to temporarily close the facility and that it had relocated its inventory farther north. In a statement posted to its website Wednesday, Baxter said that as it has ramped up production at its global facilities, most customers are now able to receive the majority of what they typically order. There is no timeline on when production will resume in North Carolina.

Florida health-care workers exhausted as Hurricane Milton approaches The Washington Post; by David Ovalle and Sabrina Malhi; 10/8/24The storm shutters are up at Stephen Johnson’s house near the water in North Fort Myers, Fla. ... But  Jones won’t be home when Hurricane Milton is expected to thunder ashore this week along the Gulf Coast. Instead, the paramedic — like thousands of health-care workers across Florida — intends to ride out the storm at work, then jump into action when the winds die down, the waters recede and people seek medical assistance. ... “It gets stressful. You don’t know if you’re going to come back to a home,” Johnson, 28, of Brewster Ambulance Service, said during a brief break Tuesday after two straight days of organizing evacuations of patients from hospitals and assisted-living facilities across Lee County in southwest Florida while surviving on granola bars and energy drinks. ... By Tuesday afternoon, Florida health officials had deployed nearly 600 ambulances, buses and other transport vehicles to ferry patients out of harm’s way. More than 200 health-care facilities — including 115 assisted-living facilities, 10 hospitals and five hospice providers — have reported evacuations, according to the state’s health department.

Temporary regulatory relief for South Carolina health care providers responding to Hurricane Helene Baker Donelson; Alissa D. Fleming; 10/4/24 South Carolina Governor Henry McMaster declared a State of Emergency on September 25, 2024, to prepare for Hurricane Helene. On September 29, 2024, the Federal Emergency Management Agency (FEMA) issued a Federal Major Disaster Declaration (FEMA-4829-DR) for South Carolina. On September 30, 2024, the United States Department of Health and Human Services (HHS) declared a public health emergency in South Carolina, and the Centers for Medicare and Medicaid Services (CMS) issued several blanket waivers to provide greater compliance flexibility and continuity of care while responding to Helene in the geographic area covered by the President's declaration. These waivers [detailed in the article] provide health care facilities with flexibility in service delivery, staffing, and patient care, aimed at alleviating the strain caused by Helene. Further, HHS, the South Carolina Department of Health and Human Services (SCDHHS), and other regulatory bodies have announced relief efforts, all aimed at reducing administrative burdens so providers can continue to care for and treat those in need. ...7. Hospices Assessment Timeframe Extension: CMS is extending the timeframe for updating comprehensive hospice patient assessments from 15 to 21 days, though initial and ad-hoc assessments must still be completed based on patient needs. ...Editor's note: Click on the title's link to continue reading. Other CMS waivers are defined for 1. General ... for Health Care Facilities; 2. Critical Access Hospictals; 3. Hospital and Long Term Care Facilities; 4. Skilled Nursing Facilities; 5. Home Health Agencies; 6. DME, Prosthetics, Orthotics, and Supplies; 7. Hospice (above); 8. Practioner Licensure and Enrollment ... HIPAA; Disaster Relief

Hospitalists use POLST to initiate patient conversations about care goals The Hospitalist; by Larry Beresford; 10/1/24 Physician orders for life-sustaining treatment (POLST) is a single-page medical order form, typically printed on bright pink paper, and signed by a physician, nurse practitioner, or physician assistant to spell out treatment preferences for a seriously ill or frail patient. It is also a process for exploring those preferences in conversation with patients and then communicating them to those who might need to know, such as EMS personnel, in some future medical emergency when the patients can no longer speak for themselves. And, said Steven Pantilat, MD, FAAHPM, MHM, a former clinical hospitalist and the inaugural chief of the division of palliative medicine at the University of California San Francisco, it is “solidly within what hospitalists can and should be doing.” That may involve meeting and talking with patients and their families about their values and treatment preferences, reviewing any existing POLST forms, and even filling out and signing a form.

16 large health systems growing bigger Becker's Hospital Review; by Alan Condon; 9/20/24 Merger and acquisition activity is rebounding after a drop in deal volume during the pandemic, with many large health systems growing their hospital portfolios or planning to add more hospitals in the coming quarters. Sixteen health systems growing bigger: ... This is not an exhaustive list.

Hospital mergers and health care price increases: A primer for reporters Association of Health Care Journalists (AHCG); by AHCG Staff; 9/24/24 Hospital mergers — market consolidation — can lead to health care price increases of anywhere from 3% to 65%, according to a 2022 RAND Corporation review. The FTC’s director of the Bureau of Economics has said hospitals that merge may charge 40% to 50% more than if they hadn’t merged. Mergers can also result in layoffs and lower tax revenues and have a negative impact on patient care by reducing access to some health care services. With so much research confirming negative effects and as health care prices continue to rise, what — if anything — can be done to slow market consolidation and/or reduce the harms to patients and local economies?