Literature Review

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. ...

Hospital-at-home care’s future still hangs in the balance Home Health Care News; by Joyce Famakinwa; 10/7/24 Even with a proven track record for clinical effectiveness and cost savings, the hospital-at-home model’s future hangs in the balance. “The data suggests that, for the populations that have been studied in multiple different places, it’s a very safe service to be done and with high-quality care, low readmission rates, low escalation rates, low infection rates,” Dr. Adam Groff, co-founder Maribel Health, told Home Health Care News. “The bottom line is people love it, patients love it and it’s a high-quality care experience.” ... In 2020, the hospital-at-home model had its breakthrough. Though the model was common internationally, it was considered niche in the U.S. This changed with the introduction of the Centers for Medicare & Medicaid Services’ (CMS) Acute Hospital Care At Home program. A recent report from CMS found that the program has been largely successful. ... Despite the momentum the model has seen in recent years, challenges still exist when it comes to operations and scalability. Specifically, less than 9% of waiver-approved hospitals accounted for more than 70% of all U.S. admissions, according to data from MedPAC’s June 2024 report to Congress. ... 

'Trying not to cry:' Helene's wrath sets new normal in battered western North Carolina townCBS WBTW-13, Florence, SC; by Adrianna Lawrence; 10/8/24 Kyle Katona has lived through his share of hurricanes. But nothing could ready him for the wrath Helene unleashed across the idyllic valleys of western North Carolina. "I've never seen the amount of devastation that Hurricane Helene caused in the mountains," the Four Seasons hospice store driver said. He wasn't alone. "I don't think anybody was prepared for the level of catastrophe that was going to occur," said Rikki Hooper, Four Seasons' clinical operations officer. Traumatized residents awoke to the sound of water coursing into their homes before the sun came up -- taking everything and, in some heartbreaking instances, everyone, with it. ... At Lake Lure -- a beloved vacation spot minutes from Chimney Rock -- mud stands in for where water once flowed. Instead, officials and first responders were providing medical treatment. Military helicopters flicked across the sky and bulldozers cleared out areas. If it sounds like a warzone, that's because it was as close as it could be to one, Pixie Moore [a resident] said. Editor's note: Click here to donate directly to Four Seasons' hurricane relief needs; or Amazon Wish List. Click here for our 10/2 interview with TCN leaders about Helene's devastation and hospice needs for Four Seasons, Amorem, Compassionate Care of Western North Carolina (CCWNC), and Carolina Caring. 

[Scotland] Palliative care-based arguments against assisted dyingBioethics; Ben Colburn; 10/24Opponents of legalised assisted dying often assert that palliative care is worse in countries where assisted dying has been legalised, and imply that legalised assisted dying makes palliative care worse. This study considers five versions of this claim: that it is difficulty to access expert palliative care in countries where assisted dying has been legalised, that those countries rank low in their quality of end-of-life care; that legalising assisted dying doesn't expand patient choice in respect of palliative care; that growth in palliative care services has stalled in countries where assisted dying has been legalised; and that legalised assisted dying impedes the growth of palliative care or causes it to decline. In each case, it concludes that neither argumentation nor evidence supports these claims.

[Sweden] Reconciliation in palliative care: A concept analysisPalliative and Supportive Care; Margareta Karlsson, Andrea Uhlman, Benedict Kämper, Britt Hedman Ahlstrom; 9/24Terminal illnesses affect almost all aspects of life and being close to death may lead to a need for reconciliation. The end of life is stressful on an existential level for both patients and relatives. It can therefore be of relevance for palliative care nurses to understand the meaning of reconciliation. We conclude that reconciliation is a concept of importance when caring for patients in end-of-life care. A broader and deeper understanding of the concept facilitates conversations about the meaning of reconciliation in palliative care and can enable patients who strive to achieve reconciliation to be more easily identified and supported.

A quality improvement initiative for inpatient advance care planningJAMA Health Forum; Olivia A Sacks, Megan Murphy, James O'Malley, Nancy Birkmeyer, Amber E Barnato; 10/24The Centers for Medicare & Medicaid Services (CMS) implemented advance care planning (ACP) billing codes in 2016 to encourage practitioners to conduct and document ACP conversations, and included ACP as a quality metric in the CMS Bundled Payments for Care Improvement Initiative in 2018. Increased ACP billing rates were significantly associated with decreased rates of inpatient death in the intervention group ... compared to the nonintervention ... and control groups ... Conclusions and relevance: This nationwide cohort study suggests that while the ACP quality initiative increased ACP billing, changes in clinical outcomes were inconsistent with the hypotheses.

Socioeconomic status and major adverse transplant events in pediatric heart transplant recipientsJAMA Network Open; Christina Hartje-Dunn, MD; Kimberlee Gauvreau, ScD; Heather Bastardi, PNP; Kevin P. Daly, MD; Elizabeth D. Blume, MD; Tajinder P. Singh, MD, MSc; 10/24In this cohort study of pediatric HT recipients, there was no difference in posttransplant outcomes among recipients stratified by SES, a notable improvement from prior studies. These findings may be explained by state-level health reform, standardized posttransplant care, and early awareness of outcome disparities.

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.

Saturday newsletters focus on headlines and research - enjoy!

Feasibility of a digital palliative care intervention (Convoy-Pal) for older adults with heart failure and multiple chronic conditions and their caregivers: a waitlist randomized control trialBMC Palliative Care; by Lyndsay DeGroot, Riley Gillette, Jennifer Paola Villalobos, Geoffrey Harger, Dylan Thomas Doyle, Sheana Bull, David B Bekelman, Rebecca Boxer, Jean S Kutner, Jennifer D Portz; 10/24Although older adults with heart failure (HF) and multiple chronic conditions (MCC) frequently rely on caregivers for health management, digital health systems, such as patient portals and mobile apps, are designed for individual patients and often exclude caregivers. There is a need to develop approaches that integrate caregivers into care. This study tested the feasibility of the Social Convoy Palliative Care intervention (Convoy-Pal), a 12-week digital self-management program that includes assessment tools and resources for clinical palliative care, designed for both patients and their caregivers. Recruiting informal caregivers proved challenging. Nonetheless, Convoy-Pal retained patients and collected meaningful self-reported outcomes, showing potential benefits for both patients and caregivers. Given the importance of a patient and caregiver approach in palliative care, further research is needed to design digital tools that cater to multiple simultaneous users.

Few older patients with advanced heart failure are evaluated for advanced therapiesCardiology Advisory; by Jessica Nye; 10/3/24Only a small proportion of older patients with advanced heart failure (HF) are evaluated for left-ventricular assist device (LVAD) implantation or heart transplant (HT) and palliative care is underutilized, according to study results submitted to the Heart Failure Society of America (HFSA) Annual Scientific Meeting 2024, held virtually from September 27 to 30, 2024... Fewer than a third of patients (29%) were referred for palliative care.

The death issue: Austin’s Children’s hospice professionals advocate for honesty The Austin Chronicle; by Maggie Quinlan; 10/11/24 Sometimes parents wait too long to tell their sick children that they will die. Sometimes, by the point of disclosure, their child can no longer speak. ... She said often the dying child will become an “emotional caretaker” in the hospital room where they’ve just learned that their illness will kill them. “Even though it’s happening to them, they tend to really want to protect their family.” It doesn’t have to be that way. Cosby says a lot of the job is beautiful, even fun. Families make memories, and child life specialists help make it happen. They go to see the ocean. They throw private proms and graduation ceremonies. They finger paint. They crack jokes. They decide to make the most of precious little time. ... “Grief is the price of love, and there’s so much love in there,” says Heather Eppelheimer, another Dell Children’s child life specialist. “We have to be able to love fully in order to also grieve fully.” Child life specialists respect family wishes and also advocate for honest, clear language about death. They say to use that word – death, dying, die – and avoid “passing away” (“To where?” Cosby asks). That kind of straightforward communication isn’t part of our cultural hardwiring, Cosby says, but it makes everything easier. In her life, when people aren’t comfortable talking about death, she asks why. What are they afraid of? ...