Literature Review

The tangled web of pediatric palliative care payment and policy Hospice News; by Holly Vossel; 8/13/24 A complex web of state regulations and reimbursement systems can challenge pediatric palliative care access for seriously ill children and their families. The nation’s fragmented health care system lacks clear guidance when it comes to navigating chronic, complex conditions in children, adolescents and young adults, according to Jonathan Cottor, CEO and founder of the National Center for Pediatric Palliative Care Homes. Much of the current state palliative regulations and reimbursement pathways focus on adult patient populations, representing a significant barrier to improved quality and support in the pediatric realm, Cottor said.

ETC model is failing to boost home dialysis utilization, nephrologists say McKnights Home Care; by Adam Healy; 8/9/24 Nephrologists are worried that the End-Stage Renal Disease Treatment Choices (ETC) model has not made good on its promise to promote home-based kidney care and advance health equity. The Centers for Medicare & Medicaid Services launched the ETC model in 2021, randomly selecting about 30% of providers treating end-stage renal disease for participation. The model uses financial incentives to encourage greater use of home dialysis treatment and increase kidney transplant access. However, these incentives have not been effective in producing their intended results, according to Amit Kapoor, MD, the chief nephrologist at Strive Health. ... A March study published in JAMA found that the ETC model may unintentionally punish providers who serve high-needs, low-income or minority patients. 

Dr. El-Jawahri on the impact of palliative care on end-of-life care for AML and MDS OncLive; by Areej R. El-Jawahri, MD; 8/12/24 Areej El-Jawahri, MD, associate director, Cancer Outcomes Research and Education Program, director, Bone Marrow Transplant Survivorship Program, associate professor, medicine, Massachusetts General Hospital, discusses findings from a multi-site, randomized trial (NCT03310918) investigating a collaborative palliative oncology care model for patients with acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) receiving nonintensive therapy at 2 tertiary care academic hospitals. Patients in the study who received the palliative care interventions had a median of 41 days from end-of-life care discussions to death, compared with 1.5 days in the standard care group (P < .001). Additionally, patients who received the palliative care interventions were more likely to articulate their end-of-life care preferences and have these preferences documented in electronic health records, El-Jawahri begins. This documentation correlated with fewer hospitalizations in the final 30 days of life, she notes. Furthermore, palliative care recipients experienced QOL improvements and a trend toward reduced anxiety symptoms vs the patients who received usual care, El-Jawahri says. These findings underscore the necessity of integrating palliative care as a standard of care for patients with AML and high-risk MDS, El-Jawahri emphasizes.

Alzheimer’s prognosis models should expand data sources McKnights Senior Living; by Kristen Fischer; 8/12/24 Integrating data from nursing home electronic health records and claims in addition to the minimum data set — data required for nursing home residents — could be better than just relying on the MDS sources to produce an accurate prognosis for nursing home residents with Alzheimer’s disease and related dementias, according to a report published Thursday in the Journal of the American Geriatrics Society. ... The authors of the report noted that a recent review of prognostic models for late-stage ADRD found that assessments commonly used to evaluate prognosis-based eligibility for hospice weren’t reliable. ... Only 15% of people enrolled in hospice have a primary diagnosis of ADRD. That’s because it’s challenging to estimate the six-month prognosis required to be eligible for hospice, and dementias have a prognosis of 12 to 18 months when they are in the late stage, the authors pointed out.

Hospice market surge: Expected to hit $182.1 billion by 2033 Market.us Media; by Trishita Deb; 7/29/24 The global hospice market is projected to grow significantly from USD 72.8 billion in 2023 to around USD 182.1 billion by 2033, achieving a CAGR of 9.6%. This expansion is primarily driven by an aging population requiring increased palliative and end-of-life care. The demographic shift necessitates services that address chronic illnesses and provide compassionate care, predominantly offered by hospices. Additionally, technological advancements, particularly in telemedicine, facilitate broader access to comprehensive care, especially in remote areas. Interdisciplinary approaches in palliative care are also pivotal, involving collaborative efforts from doctors, nurses, social workers, and chaplains. This holistic method not only enhances the quality of care but also boosts patient and family satisfaction, key metrics in healthcare evaluations. 

Cultivating humility, making connections in a contentious world Tallahassee Democrat; by Rev. Candace McKibben; 7/27/24 The first time I remember hearing about “cultural humility” was some years ago when I served as a member of the Diversity and Inclusion Team at Big Bend Hospice. I recall reading an article by Silvia Austerlic, a Bereavement Manager and Hospice Latino community liaison, at Hospice of Santa Cruz County. She explained what is required to relate in the best interests of patients and families is not “cultural competence,” which is where our team had been focused, but “cultural humility.” “Cultural competence,” while it may be well-meaning, is a framework to help providers understand, appreciate, and work with individuals from diverse cultures. It is focused on gaining knowledge. “Cultural humility,” on the other hand, is focused on relationships. ... Yet another form of humility that seems critically important to me in our time is “religious humility.” This form of humility involves celebrating the inherent dignity of every individual, regardless of their religious affiliation.

Palliative Medicine - June 2024 Issue

Palliative care benefit work group Office of the Insurance Commissioner - Washington State; 7/23/24 The Washington state Legislature has directed the Office of the Insurance Commissioner, in consultation with the Health Care Authority, to convene a work group to design the parameters of a palliative care benefit and payment model for fully insured health plans. The work group must submit a report to the Legislature detailing its work and any recommendations by November 1, 2025. The work group must consider the following elements of a palliative care benefit: 

Sasha McAllum Pilkington on grace and storytelling at the end of life Psychotherapy.net; by Lawrence Rubin; 7/22/24 Narrative Clinician, Sasha McAllum Pilkington [of New Zealand],  shares poignant stories she co-created with hospice clients which honor and celebrate their lives. [This interview includes: ...]

What does "palliative care" represent in research using secondary data? Journal of Pain and Symptom Management; by J. Brian Cassel; 7/18/24 While much research has been done regarding "palliative care" using retrospective cohort studies of large datasets, the data sources may not be capturing specialty palliative care services. This article aims to clarify what source data are used in such studies, how specialty palliative care services are determined to have been provided or not, and mismatches between the nature of the data and the interpretation of researchers. 

Palliative pharmacotherapy for cardiovascular disease: A scientific statement from the American Heart Association Circulation: Cardiovascular Quality and Outcomes - American Heart Association (AHA) / American Stroke Association (ASA); by Katherine E. Di Palo, PharmD, MBA, MS, FAHA, Shelli Feder, PhD, APRN, ACHPN, FPCN, FAHA, Yleana T. Baggenstos, PharmD, Cyrille K. Cornelio, PharmD, Daniel E. Forman, MD, Parag Goyal, MD, MSc, Min Ji Kwak, MD, MS, DrPH, and Colleen K. McIlvennan, PhD, DNP, FAHA on behalf of the American Heart Association Clinical Pharmacology Committee of the Council on Clinical Cardiology and Council on Cardiovascular and Stroke Nursing; 7/24 ... Compared with other serious illnesses, medication management that incorporates a palliative approach is underused among individuals with cardiovascular disease. This scientific statement describes palliative pharmacotherapy inclusive of cardiovascular drugs and essential palliative medicines that work synergistically to control symptoms and enhance quality of life. We also summarize and clarify available evidence on the utility of guideline-directed and evidence-based medical therapies in individuals with end-stage heart failure, pulmonary arterial hypertension, coronary heart disease, and other cardiomyopathies while providing clinical considerations for de-escalating or deprescribing. Shared decision-making and goal-oriented care are emphasized and considered quintessential ... across the spectrum of cardiovascular disease.

Bridge the gap: Addressing rural end-of-life care disparities and access to hospice services Journal of Pain and Symptom Management; by Asif Anwar, Muhammad Kashif Amin, Sherezaad Anwar, Moazzam Shahzad; 7/11/24 online ahead of print Rural hospices face many obstacles in delivering palliative and end-of-life care in the United States. We aimed to identify these barriers and their potential solutions. ...  We propose several potential solutions to overcome these hurdles and improve access. ... Advanced practice providers should be considered to serve as physician heads in rural hospices, which would expand resources in areas with physician shortages. A single per diem payment model should be implemented for rural hospices, regardless of the level of care provided, to help offset the higher cost of care. he Critical Access Hospital program and offering cost-based reimbursement for swing-bed stays could improve access to post-acute care, including hospice services. Telehealth can improve the timeliness of care and reduce travel costs for patients and providers.  [Continue reading for more solutions.]