STUDY SHOWS HOSPICES OFFER FINANCIAL BENEFITS TO THE HEALTH CARE SYSTEM AND TO FAMILIES

 

While it has been shown in the past that the provision of hospice care saves money for Medicare, researchers did not know if “hospice saves money across all payers, including whether it shifts costs to families.” Researchers completed a study to find out.

 

The study, reported in JAMA Network, used data from 2002 to 2018. They measured costs across all settings—out-of-pocket costs to families, “Medicare, Medicare Advantage, Medicaid, private insurance, private health maintenance organizations, Veteran’s Administration, and other) and by expenditure type (inpatient care, outpatient care, medical visits, skilled nursing, home health, hospice, durable medical equipment, and prescription drugs).” The study included data on 5464 decedents with a mean age of 78.7 years. Of these, 38% were served as hospice patients.

 

The data show that costs for care were lower for hospice patients during the period of the last 3 days to the last three months of life. “The magnitude of lower out-of-pocket spending to families who enrolled with hospice is meaningful to many Americans, particularly those with lower socioeconomic status.”

 

This cohort study suggest that hospice “is an example of a health care model that demonstrates both components of the value proposition: it improves the quality of end-of-life care and is associated with lower health care costs. Moreover, unlike many other aspects of our health care system, cost reductions to insurers in the present study did not translate into higher costs for patients and their families.”

 

The JAMA Network article, which is online at the link below, shares details, methodology and outcomes of the study. (JAMA Network, 2/11, https://jamanetwork.com/journals/jama-health-forum/fullarticle/2788935)

 

 

HOSPICE NOTES

 

* End of Life University offers a podcast titled “Feng Shui for Hospice Patients with Char Tarashanti.” Tarashanti is both a retired hospice chaplain and a certified Fen Shui consultant. In the podcast, Tarashanti offers insights into the use of Fen Shui to create a “pleasing and appealing surrounding for people at the end of life.” The first link below is to the podcast, and the page also includes a handout Tarashanti shares. (End of Life University, 2/21, https://eolupodcast.com/2022/02/21/ep-339-feng-shui-for-hospice-patients-with-char-tarashanti/?mc_cid=1dcfba2302&mc_eid=d0771da91c)

 

* Hospice fraud is the topic of an article in Los Angeles Times. The article is titled “Doctors, nurses and others charged with taking kickbacks in end-of-life fraud case.” California prosecutors say two couples took more than $4.2 million and “paid doctors and others for bogus diagnoses or illegal kickbacks for patent referrals—accusations that mirror the type of widespread hospice fraud” reported in an earlier (2020) article. The California AG says that 16 people face felony charges, and all but two of these has been arrested. The accused fraud includes New Hope Hospice Inc. and Sterling Hospice Care Inc. in San Bernardino County. The article, online at the link below, shares more about this case and about California’s efforts to address fraud in end-of-life care. (Los Angeles Times, 2/24, https://www.latimes.com/california/story/2022-02-24/doctors-nurses-charged-medicare-hospice-fraud-scheme )

 

* A blog post on sevenponds shares how “AI Algorithms Help Guide Decisions in Palliative Care.” The post shares about the work of using AI and gives examples of how it is being used. (blog.sevenpods, 2/20, https://blog.sevenponds.com/something-special/ai-algorithms-help-guide-decisions-in-palliative-care)

 

 

PALLIATIVE CARE NOTES

 

* Support Cancer Care offers a study that examines the “association between administration of ICI therapy [immune checkpoint inhibitors] and the duration of involvement of the palliative care team (PC) team, among patients with advanced caner who died in-hospital.” Researchers conclude that the use of ICI therapy near life’s end “should not delay PC referral.” Better communication between PC providers and oncological teams is needed. (Pub Med, 2/22, https://pubmed.ncbi.nlm.nih.gov/35192058/)

 

* Serious illness communication (SIC), says an article in HealthLeaders, is “both a complicated and delicate process.” Providers of palliative talk with patients and families “about everything from life expectancy to end-of-life care.” These conversations are then entered in electronic health records and, ultimately, available to others. Each step, says the article, can create a bottleneck in the process. Also, many clinicians lack SIC training, and “there are no clear standards to document how he process should be conducted…” Researchers from Brigham and Women’s Hospital and Massachusetts General Hospital “say AI technology could be used in a hybrid platform that improves how clinicians communicate with patients and their families about these serious illnesses and palliative care. AI can be used to “gather and interpret data” and to streamline the process. With the use of natural language processing (NLP) these tasks may be done with less effort and time. “‘AI-assisted chart reviews have demonstrated higher accuracy and shorter time for extracting relevant patient information compared with standard chart reviews.’” (HealthLeaders, 2/21, https://www.healthleadersmedia.com/technology/how-can-ai-be-used-palliative-care)

 

* An article in Patient, a publication from UK, shares “LGBTQI+: what are the barriers and challenges in end of life care?” The article address challenges and barriers to appropriate care for LGBTQI+ that arise either intentionally or unintentionally. The article shares research from UK, explores challenges in care, and explores discrimination and the outcome of these actions. The article then addresses how a “welcoming environment” is created. (Patient, 2/23, https://patient.info/news-and-features/lgbtqi-what-are-the-barriers-and-challenges-in-end-of-life-care)

 

* A GeriPal podcast explores the value of Advance Care Planning (ACP). The podcast features Juliet Jacobsen and Rachelle Bernacki who are two of the authors of JAMA’s viewpoint titled, “Shifting to Serious Illness Communication.” The two discuss the ongoing debate about the value of advance care planning, and they discuss what is to be included in “high quality conversations.” The podcast is online at the link below. (Geripal, 2/24, https://geripal.org/should-we-shift-from-advance-care-planning-to-serious-illness-communication/)

 

* Next Avenue shares “Palliative Care is Not Just for the Dying.” The article examines how COVID has demonstrated “how palliative care can also be valuable for managing the pain and stress of illness.” The article describes palliative care, and notes that palliative care’s holistic view is an appropriate service for many. One physician says palliative care is good for anyone who has experienced a “‘life-defining’ or ‘life-altering’” condition. (Next Avenue, 2/21, https://www.nextavenue.org/palliative-care-is-not-just-for-the-dying/)

 

 

END-OF-LIFE NOTES

 

* Kentucky’s HB149 would allow terminally ill Kentuckians to “talk openly and honestly about end-of-life options with their medical providers and families.” An article in North Kentucky Tribune shares the experience of several Kentuckians who traveled elsewhere to receive this medical assistance in dying. About 755% of Americans support medical aid in dying, says the article, according to a 2020 Gallup poll. (North Kentucky Tribune, 2/23, https://www.nkytribune.com/2022/02/kentucky-sees-growing-support-for-medical-aid-in-dying-bill-as-new-legislation-is-being-considered/)

 

* CBN News shares about a federal lawsuit that challenges California’s End of Life Options Act, SB380. Physician Leslee Cochrane, along with the Christian Medical and Dental Associations, filed the case. The lawsuit says that recent changes to the law “eliminate important safeguards from the End of Life Options Act but also force conscientious physicians to participate  the process.” The article examines the law and the specific concerns of the lawsuit. California’s Attorney General indicates that the law will be enforced. (CBN News, 2/23, https://www1.cbn.com/cbnnews/us/2022/february/christian-doctors-sue-california-over-forced-participation-in-assisted-suicides)

 

* When Brian Ameche, “an accomplished architect and former Yale football player,” received an Alzheimer’s diagnosis, he decided he would “rather die on my feet than live on my knees.” He spoke with his wife, author Amy Bloom, and told her he wanted her help and that he wanted her to write about this. As his life began to change from the Alzheimer’s symptoms, he begin to write goodbye notes to those he loved—and he had “made up his mind to end his life.” After considering options, they located Switzerland’s Dignitas. Dignitas is described by Bloom as the only place an American citizen without a six-month prognosis for life can go for help in dying. Bloom has written the book she promised Ameche. It is titled “In Love.” (New York Times, 2/27, https://www.nytimes.com/2022/02/27/books/in-love-amy-bloom.html)

 

 

GRIEF AND ADVANCE CARE PLANNING NOTES

 

* MIDEO CARD, which stands for My Informed Decision on MIDEO, is an app that helps create both a video advance directive and “a video medical order for life-sustaining treatment.” The new app uses the patient’s own words and offers patients a chance to share their wishes with their healthcare professionals. The MIDEO creates “a digital footprint” and “allows all providers access to it regardless of the healthcare system or state.” The app is completed with a QR code and a smart device, using a team of experts who help patients identify healthcare options and personalize them for the patient. The article, using the link below, explains more about the app and the process. (Nurse.org, 2/28, https://nurse.org/articles/mideo-app-advanced-directives/)

 

OTHER NOTES

 

* The U.S. Cybersecurity and Infrastructure Security Agency (CISA) issued a “‘Shields Up’ warning to the U.S. private sector, including health care, based upon the increased cyberthreat posed by the Russian government.” The American Hospital Association (AHA) alerted all members of this action and shared resources for action. The AHA notice is online at the first link below. The CISA alert is found at the second and third links below. (AHA, 2/23, https://www.aha.org/advisory/2022-02-23-us-declares-start-russias-invasion-ukraine-introduces-sanctions-cyber-shields; CISA, 2/1, https://www.cisa.gov/news/2022/02/16/new-cybersecurity-advisory-protecting-cleared-defense-contractor-networks-against; CISA, 2/16, https://www.cisa.gov/uscert/ncas/alerts/aa22-047a )

 

 

* An article in Healio News focuses on the value of music for relieving pain. Numerous groups, including the National Academies of Science, Engineering and Medicine, NIH, and others are encouraging “nonpharmacological approaches to pain management.” Seppo Soinila, a Finnish MD, PhD, and professor of neurology, says in a review he wrote in the Journal of Pain, “‘Music should be considered as an evidence-based part of pain treatment regimens…’” The article includes an interview with Soinila and delves into his understanding of music as therapy. (Healio News, 2/23, https://www.healio.com/news/primary-care/20220223/qa-music-may-be-useful-effective-and-harmless-pain-management-strategy)

 

Hospice Analytics is the national sponsor of Hospice News Network for 2022. Hospice Analytics is an information-sharing research organization whose mission is to improve hospice utilization and access to quality end-of- life care. For additional information, please call Dr. Cordt Kassner, CEO, at 719-209-1237 or see www.HospiceAnalytics.com.

 

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