Literature Review

‘Global problem’: Numerous factors, biases contribute to overtreatment at end of life Healio; by Josh Friedman; 2/26/25 Nathan I. Cherny, MD, has worked all around the world. At every stop — from Australia to Israel, and Memorial Sloan Kettering Cancer Center in between — he has seen people with cancer receive overly aggressive treatment at the end of life. ... In a review published in ESMO Open, Cherny and a cohort of multinational colleagues highlighted numerous reasons why overtreatment occurs among patients approaching the end of life, ... They listed more than 20 contributing factors, including desire for control of the cancer, denial and anger, family pressure and hope preservation. The two factors that contribute most to overtreatment are optimism bias and the “counterphobic determination to treat,” which involves clinicians having a difficult time introducing the suggestion of palliative care revert to offering further treatments, Cherny said. ... Responsibility for decisions does not need to fall solely on oncologists, Cherny added. Palliative care physicians, social workers, chaplains and others can be part of a team to assist patients with their choices. ... The number of patients who are overtreated differs at each institution. “Each institution has its own culture of care,” Cherny said. Editor's note: This article puts forth significant insights for all palliative and hospice clinicians, interdisciplinary teams, and palliative/hospice executive leaders. Apply Cherny's to your referral sources: "Each institution has its own culture of care." Apply these findings to your own palliative and hospice services. 

Keeping cool when debate turns hot: Inaugural global Ethics Center conference features scholarship, presentations on fostering civil, productive dialogue The Harvard Gazette; by Christy DeSmith; 2/24/25 Americans today are wrestling with how to turn down the heat when discussing politically and morally charged topics. Students, professors, and education professionals from around the globe assembled at Harvard this month to chart their way to more productive discussions — and better relations. The inaugural Challenging Barriers to Civil Discourse conference, hosted by the Edmond and Lily Safra Center for Ethics, featured scholarship on fostering open, honest exchanges across deep divides. ... [Dr. Julia] Kolak told of mediating clashes that arose ... when the family of a critically ill patient ... resisted end-of-life care. She works to unearth the principles guiding all parties, without elevating those with medical expertise. “When we treat others as capable of dialogue,” she offered, “it really changes the affective grip of conflict. ... [Jeffrey Dunn] raised the critical question: “What is the long-term goal of this work?” ...

Why being trustworthy is a leadership hack that drives success Inc.; by Yufie Ren; 2/20/25 Leaders who cultivate trust can significantly reduce employee churn and improve organizational performance. ... In an era of rapid change, when teams look to leaders for stability and direction, trust is the invisible currency that fuels organizational success. ... Fortunately for managers – and workers – there’s a lot of research into how to be a more trustworthy leader. Here are a few insights:

Hospice Insights Podcast - Controlling the narrative: A new tactic for auditors and ALJs JD Supra; by Bryan Nowicki and Meg Pekarske; 2/19/25 Hospices that have gone through audits are familiar with certain recurring reasons why auditors deny claims. Two common reasons are the lack of support for a six-month prognosis and the insufficiency of the physician narrative. In this episode, Husch Blackwell’s Meg Pekarske and Bryan Nowicki discuss a new twist on these kinds of denials, and how hospices can strengthen their documentation to try to avoid them.

Home health, hospice CEO average pay tops $400K: report McKnights Home Care; by Adam Healy; 2/19/25 The Hospital & Healthcare Compensation Service’s newly released 2024-2025 Multi-Facility Corporate Compensation Report offered an in-depth look at home health  and hospice executives’ average earnings. The average CEO salary at a multifacility home health and hospice firm was $403,000, with the top 10% earning $603,000 and the bottom 10% making $278,000. Average salaries varied among other C-suite executives, with chief operating officers earning $247,000, top financial executives earning $265,000, and chief medical officers earning $285,000, on average, according to the report. 

New tech, new problems: Why application development needs a big-picture view Software Development Times (SD Times); by Sharul Sangl; 2/19/25... [Many] organizations have approached [technology] innovation without a comprehensive strategy or holistic view of their applications, simply focusing on adding the latest features or trendy tools. As a result, they are facing challenges related to application performance, scalability, efficiency, and security. To ensure the success of application innovation, enterprises must maintain a big-picture view of their applications.  ... When approached strategically, organizations are in a prime position to capitalize on current technologies to truly innovate. ...

Hospice finance 101 and the gift of mortalityPost Independent; by Peter Schoomaker, Homecare & Hospice of the Valley CFO; 2/19/25... [Practical information about hospice expenses, like labor and mileage reimbursement with. "For our agency, we estimate our clinicians will drive more than 250,000 miles in 2025, slightly more than the distance from the Earth to the Moon."] And now a more personal note … I am grateful for the last seven years of my career working in hospice care. Most importantly, I am grateful for the opportunity to integrate into the clinical experience of hospice. When I shadow an admission visit or attend the hospice interdisciplinary meeting, I am reminded that hospice is a world of YET (You’re Eligible Too). The only thing that separates me, and our hospice patients, is time. My relative physical strength will eventually shrink. My mental faculties will fade. And there is a large possibility, at some point in my life, that I will depend almost entirely on others to help with most activities of daily living. This is true for all of us. ... ... Recognizing this truth opens a path to humility. A path to step away from the ego, even for a moment, and really let go. ... When I reflect on this, I realize what a gift our mortality is. To know that our choices matter because we never know much time we have left. A sincere thank you to all our hospice, homecare and private duty clinicians — and our administrative teams that support them. It is genuinely noble work.Editor's note: "A sincere thank you" to Peter Schoomaker, Homecare & Hospice of the Valley CFO

As hospitalists’ role grows, so do the ethical dilemmas Medscape; by Donavyn Coffey; 2/17/25 Margot Eves, JD, clinical ethicist for Cleveland Clinic, was called in for an emergency consult: A man in his early 50s was asking doctors to take him off the ventilator. Just 24 hours before, the man with chronic obstructive pulmonary disease (COPD) okayed the life-saving treatment. The hospitalist over his care expected him to come off the ventilator in a few days, but 24 hours was too soon. He wouldn’t survive. With head nods and in writing the patient signaled that he was fully aware — he understood this would end his life. Eves was called in to help weigh the options: Honor the patient’s wishes or help him survive. These kinds of ethical dilemmas have become common to the burgeoning hospitalist profession. ....

What's keeping CFOs up at night? Becker's Hospital CFO Report; by Alan Condon; 2/14/25 As health system CFOs chart their course for 2025, they face an increasingly complex financial landscape marked by mounting labor costs, tightening margins, shifting payer dynamics and an evolving regulatory environment. ... [Several] CFOs recently joined the “Becker's CFO and Revenue Cycle Podcast” to discuss the trends they're watching most closely — and the strategies they're deploying to stay ahead. [Key items include the following: labor shortages (key theme); major investments in ambulatory care facilities; AI to support operations and service; physician partnerships; shift from fee for service to value-based care; clinical labor; malpractice litigation; growth of Medicare Advantage programs; staffing shortages; inflation; reimbursements; providing care to undersinsured patients; Medicaid supplemental funding programs; "disruptors' by private equity and "other nontraditional players"; uncertainty of federal and state regulation changes.]

Hospice leaders applaud CMS’s decision to reevaluate Special Focus Program, call for meaningful reforms National Alliance for Care at Home, Washington, DC and Alexandria, VA; Press Release; 2/14/25 Effective February 14, 2025, the Centers for Medicare & Medicaid Services (CMS) has ceased the implementation of the Hospice Special Focus Program (SFP) so that CMS may further evaluate the program. This decision is a positive move acknowledging that the current approach is not working as intended. The hospice community has long advocated for strong oversight and patient protections, but the SFP, as implemented, was deeply flawed, unlawful, and harmful to the very patients it was meant to protect. A multi-state coalition of hospices and hospice associations took legal action in January to challenge the program, citing its misrepresentation of hospice compliance records, misleading data, and jeopardized access to high-quality end-of-life care. The flawed algorithm behind the SFP failed to distinguish fraudulent providers from reputable ones, disproportionately penalized well-established hospices, and ignored repeated warnings from congressional leaders and industry stakeholders. ... Now that CMS is reassessing its approach, there is an opportunity to ensure that oversight efforts truly enhance patient protections without restricting access to trusted hospice providers. The National Alliance for Care at Home (the Alliance) and the National Partnership for Healthcare and Hospice Innovation (NPHI) remain committed to protecting access to high-quality hospice care and ensuring that regulatory oversight is fair, transparent, and aligned with congressional intent. ... [Click on the title's link to continue reading.] 

Avow completes $35,000 training grant provided by FutureMakers Coalition Florida Weekly - Fort Myers Edition, Fort Myers, FL; 2/12/25 Avow recently completed the Healthcare Leadership course as part of a $35,000 grant awarded by FutureMakers Coalition at Collaboratory. Made possible by nearly $23 million in federal funding from the Economic Development Administration’s Good Jobs Challenge, FutureMakers Coalition connects those who need to reskill and/or upskill any, including underemployed and unemployed, Southwest Florida residents with training for industry-recognized credentials and, ultimately, careers with local employers committed to this partnership.

Leaders-First Leadership and the 9 Touchstones with Jes Deshields Teleios Collaborative Network (TCN); podcast by Chris Comeaux; 2/12/25 Jes DeShields, founder of Crescent Leadership, discusses her leadership journey, emphasizing the importance of self-discovery, personal stories, and sustainable growth.  She introduces the concept of 'crescendo' in leadership development, which occurs when the journey builds to a key pivot point or impact point. The discussion also covers the significance of integrity in leadership, the balance between confidence and self-reflection, and the leader-first leadership model, which prioritizes leader growth to foster effective organizational change. Then, it delves into the nine touchstones of effective leadership, which are the title of Jes’ book, 9 Leader Touchstones.