Literature Review

10 key Medicare Advantage updates in 2024 Becker's Payer Issues; by Rylee Wilson; 6/27/24 The first half of 2024 brought shifting trends for Medicare Advantage. Payers continued to warn of rising medical costs in the MA population, and some are predicting they will lose members next year. Insurers picked up a win in June when CMS said it would recalculate star ratings for 2024. Here are 10 key Medicare Advantage updates to know: 

Supporting the grieving child and family: Clinical reportPediatrics; by David J. Schonfeld, MD, FAAP; Thomas Demaria, PhD; Arwa Nasir, MBBS, MSc, MPH, FAAP; Sairam Kumar, MD, FAAP; Committee on Pyschosocial Aspects of Child and Family Health; Council on Children and Disasters; 6/17/24At some point in their childhood, the majority of children will experience the death of a close family member or friend. Approximately 1 in 20 children in the United States experiences the death of a parent by the age of 16. ... The death of someone close to a child often has a profound and lifelong effect on the child and results in a range of both short- and long-term reactions. ... This clinical report offers practical suggestions on how to talk with grieving children to help them better understand what has happened and its implications. An understanding of guilt, shame, and other common reactions as well as an appreciation of the role of secondary losses and the unique challenges facing children in communities characterized by chronic trauma and cumulative loss will help the [healthcare professional] to address factors that may impair children’s adjustment and to identify complicated mourning and situations when professional counseling is indicated. Advice on how to support children’s participation in funerals and other memorial services and to anticipate and address grief triggers and anniversary reactions is provided. ...Editor's Note: This significant article can be downloaded and shared with your organization's clinicians. For additional, ongoing resources, explore the National Alliance for Children's Grief. If your hospice provides specialized children's grief services, are they listed on the NACG's "Find a Support Center or Camp Near You" search engine? Click here to add or update your listing.

‘Normalizing’ Trauma-Informed Hospice Care Delivery Hospice News; by Holly Vossel; 7/2/24 Stakeholders and advocacy organizations recently collaborated to develop stronger trauma-informed care delivery guidelines that help hospices better address violence, abuse and neglect among serious and terminally ill populations. The global anti-violence advocacy organization NO MORE in concert with the National Partnership for Healthcare and Hospice Innovation (NPHI) recently unveiled a resource guide to help strengthen hospice providers’ understanding of traumatic experiences and their impact on end-of-life outcomes. “Understanding that elder abuse and domestic violence are two really distinct and prevalent issues in the older population has really become front and center,” NPHI President Carole Fisher told Hospice News. “These victims often suffer in silence, and we need to pay better attention to their issues.” The guide, dubbed Breaking the Silence: Addressing Domestic Violence, Elder Abuse and Neglect, is one of many steps needed in developing more supportive structures for patients and their families, according to Fisher. A main aim is to illuminate the prevalence of abuse and trauma and to arm hospice providers with tools to shape more innovative trauma-informed care models, she said.Editor's Note: NPHI is a sponsor. This significant Guide pairs with readers' "Top Read" articles we posted recently:

New ER program helped more patients get needed hospice care U.S. News & World Report; by Carole Tanzer Miller, HelathDay Reporter; 7/9/24 One hospital's push to transition patients who are nearing the end of life from the emergency room to hospice care appears to be working. After the program went into effect, 54% of ER patients at Brigham and Women's Hospital in Boston transitioned to hospice care within 96 hours. That compared to 22% before the program began in 2021. Their findings suggest that such programs may help adults who present at the ER near the end of life avoid delayed or missed hospice care. "When patients come to an emergency room near end of life, the default is typically to admit them to the hospital, engage them in conversations about goals and end-of-life care and potentially move them into hospice care," said first study author Dr. Christopher Baugh, an emergency department physician at Brigham and Women's. "However, this lengthy progress can take longer than the patient has left to live." He said the new program helps doctors quickly identify patients who are eligible for hospice care and get them there quicker. In hospice care, attempts to cure a person's illness are stopped and the focus shifts to comfort care and family support. ... The findings were reported July 8 in the journal JAMA Network Open.

CMS: GUIDE Model Infographic, Facts, and Participants CMS.gov and various press releases; retrieved from the internet 7/10/24 The Guiding an Improved Dementia Experience (GUIDE) Model is a voluntary nationwide model test that aims to support people with dementia and their unpaid caregivers. The model began on July 1, 2024, and will run for eight years. Editor's Note: Since the release of GUIDE's formal press release on 7/8 and our post yesterday (7/10), numerous press releases have already populated across the internet. We re-share this list of links to the GUIDE's information, participants, paired with new, sample press releases from 3 of the 400 participants. 

3 pillars of effective hospice sales Hospice News; by Jim Parker; 7/8/24Hospices seeking to grow should consider building a culture of compliance driven by data, effective system design and accountability, including for its sales force. Compliance and sales should walk hand-in-hand, according to a recent report from the Transcend Strategy Group. This can help prevent sales staff from running afoul of regulations inadvertently as well as support sustainable growth, according to Tony Kudner, chief strategy officer for Transcend. ... “[Without] understanding of what the rules of the road are, you’re going to run into trouble,” he said. “Though no one-size-fits-all approach exists, providers can adapt three overarching strategies to support this kind of culture.”

Sunday newsletters focus on headlines and top read stories of the last week (in order) - enjoy!

NHPCO Celebrates the life of Dr. Bernice Catherine HarperNHPCO press release; 7/11/24The National Hospice and Palliative Care Organization (NHPCO) and the NAHC-NHPCO Alliance mourn the recent passing of Dr. Bernice Catherine Harper, MSW, MScPH, LLD, and celebrate her remarkable life of leadership and service to our professional community and the world. Dr. Harper’s lifelong leadership had profound and lasting positives impact across social work; hospice care; and diversity, equity, inclusion, and belonging (DEIB).

Successful use of propofol after failed palliative sedation in patients with refractory symptoms[Spain] Journal of Palliative Medicine; Eduardo Garcia Romo, Bernadette Pfang, Beatriz Valle Borrego, Marta Lobo Antuña, Antonio Noguera Tejedor, Silvia Rubio Gomez, Victoria Galindo Vazquez, Blanca Prieto Rios; July 2024Propofol is a general anesthetic used in multiple clinical scenarios. Despite growing evidence supporting its use in palliative care, propofol is rarely used in palliative sedation. Reluctance toward the adoption of propofol as a sedative agent is often associated with fear of adverse events such as respiratory arrest. We aimed to describe efficacy and safety of palliative sedation in refractory sedation with propofol using a protocol based on low, incremental dosing. Conclusion: A protocol for palliative sedation with propofol based on low, incremental dosing, with the option of administering an initial induction bolus, shows excellent results regarding adequate levels of sedation, without observing apnea or respiratory depression. Our results promote the use of propofol to achieve palliative sedation in patients with refractory symptoms and risk factors for complicated sedation at the end of life.Publisher's Note: An interesting study on palliative sedation, although findings would need to be put into an American context.

Disparities in end-of-life care for minoritized racial and ethnic patients during terminal hospitalizations in New York StateJournal of the American Geriatrics Society; Miguel Cid, Main Lin Quan Vega, Zhixin Yang, Jean Guglielminotti, Guohua Li, May Hua; 7/24Racial and ethnic minorities often receive care at different hospitals than non-Hispanic white patients, but how hospital characteristics influence the occurrence of disparities at the end of life is unknown. ... During terminal hospitalizations, Black patients were less likely than non-Hispanic White patients to have documented end-of-life care. This disparity appears to be more pronounced in non-teaching hospitals than in teaching hospitals.

The unintended and anticompetitive consequences of laws to control health care costsJAMA Forum; by Lanhee J. Chen; 6/24An array of federal and state laws, and accompanying regulations, restrict the supply of health care, driving up costs and making health care less affordable and accessible for many in the US. Too few health policy analysts and commentators have paid attention to these supply-side limitations that play a significant role in limiting the number of clinicians and health care facilities. Even though some of these policies were well-intentioned and designed to control costs, they have, in practice, undermined competition and ironically led to higher prices in the long run... Together, CON and COPA laws, as well as the ACA restrictions on POHs, have been associated with a host of unintended consequences, such as the aggregation of market power in increasingly larger health care facilities, limited access to care, and higher costs for patients. Indeed, these supply-side restrictions have been critiqued by analysts across the ideological spectrum. Policymakers at both the state and federal level should take note of the unintended effects of these laws and their accompanying regulatory provisions and consider whether their repeal or modification would benefit patients and the communities where they live.

A Hospice Transitions Program for patients in the Emergency Department JAMA Network Open; by Christopher W. Baugh, MD, MBA; Kei Ouchi, MD, MPH; Jason K. Bowman, MD; Ayal A. Aizer, MD; Alexander W. Zirulnik, MD, MPH; Martha Wadleigh, MD; Angela Wise, MHA; Paula Remón Baranda, MEM; Richard E. Leiter, MD, MA; Bradley J. Molyneaux, MD, PhD; Andrea McCabe, RN; Panupong Hansrivijit, MD; Kate Lally, MD; Melissa Littlefield, MBA; Alexei M. Wagner, MD, MBA; Katherine H. Walker, MD, MSc; Hojjat Salmasian, MD, MPH, PhD; Kourosh Ravvaz, MD, PhD; Jada A. Devlin, BSN; Karen Lewis Brownell, RN, BSN, CEN; Matthew P. Vitale, MD; Frantzie C. Firmin, MS, RN; Nelia Jain, MD; Jane deLima Thomas, MD; James A. Tulsky, MD; Soumi Ray, PhD; Lynne M. O’Mara, MPAS, PA-C; Elizabeth M. Rickerson, MD; Mallika L. Mendu, MD, MBA; 7/8/24Patients often visit the emergency department (ED) near the end of life. Their common disposition is inpatient hospital admission, which can result in a delayed transition to hospice care and, ultimately, an inpatient hospital death that may be misaligned with their goals of care. Conclusions and relevance: In this quality improvement study, a multidisciplinary program to facilitate ED patient transitions was associated with hospice use. Further investigation is needed to examine the generalizability and sustainability of the program.Editor's Note: We posted an article on 7/10/24 that describes the significance of this research,"Study finds new program streamlined hospice transitions from the emergency department." 

Prognoses associated with Palliative Performance Scale scores in modern palliative care practiceJAMA Network Open; by Kara E Bischoff, Kanan Patel, W John Boscardin, David L O'Riordan, Steven Z Pantilat, Alexander K Smith; 7/1/24The Palliative Performance Scale (PPS) is one of the most widely used prognostic tools for patients with serious illness. However, current prognostic estimates associated with PPS scores are based on data that are over a decade old. ... Conclusions and relevance: In this prognostic study, prognostic estimates associated with PPS scores were substantially longer than previous estimates commonly used by clinicians. Based on these findings, an online calculator was updated to assist clinicians in reaching prognostic estimates that are more consistent with modern palliative care practice and specific to the patient's setting and diagnosis group.