Wednesday, June 22, 2016

Personalize Your Care Act Provides Tools Needed to Make Important Care Planning Decisions

As America’s aging population grows, individuals with chronic and advanced illnesses will need access to resources and tools to help make informed choices about advance care planning.  The Personalize Your Care Act of 2016, introduced today by Congressman Earl Blumenauer (D-OR) and Congressman Phil Roe (R-TN), increases accessibility to and public awareness of advance care planning.  It also authorizes a demonstration project to allow individuals with advanced illness to access hospice and palliative care services without forgoing conventional therapies. 

“The National Hospice and Palliative Care Organization enthusiastically supports the Personalize Your Care Act of 2016 and applauds the leadership of Representatives Blumenauer and Roe,” said President and Chief Executive Officer of NHPCO, J. Donald Schumacher. “Self-determination is at the core of the hospice philosophy and care model, and we believe that the Personalize Your Care Act will allow some of our most vulnerable patients to have information and support they need to make healthcare decisions. 

The introduction of the legislation coincides with a Congressional screening of the PBS Frontline documentary “Being Mortal” NHPCO is hosting Wednesday, June 22.  Best-selling author and physician Dr. Atul Gawande will be joined by singer, songwriter, and family caregiver Rory Feek in a panel discussion on how we, as a nation, can provide better care for people with serious, potentially life-limiting illness. 

“Conversations about end-of-life care can be difficult, but it’s extremely important for patients and their families to make these decisions with their medical providers,” says Congressman Roe. “I’ve been on both sides of these discussions – as a physician and a family member – and I know firsthand the peace of mind that comes with knowing a patient or loved one’s wishes. This bill will ensure patients, families and medical professionals have the resources and tools they need to navigate these sensitive but necessary conversations, and I am proud to partner with Congressman Blumenauer on this legislation.” 

The Personalize Your Care Act will increase public awareness through additional Medicare coverage for Advanced Illness Management and Choices Demonstration which allows more accessibility and more choices in care services.  The legislation also requires that advance directives be included within a patient’s electronic health record in order to increase the likelihood that the documents are kept up-to-date and easy to locate.  

"Medicare providers are now being reimbursed for having thoughtful and thorough conversations with patients and their families about end-of-life choices. Our legislation builds on what we’ve accomplished to further ensure patients’ wishes for care are understood, respected, and enforced.” said Congressman Blumenauer. 

As an organization committed to increasing awareness of advance care planning, NHPCO provides free information and tools to the public.  NHPCO’s Caring Info has state-specific advance directive forms and information on advance care planning that can be downloaded from its website   Each state’s advance directive is legally reviewed on an annual basis and meets each state’s statutory requirements.

Monday, June 13, 2016

NHPCO Statement on the Tragedy in Orlando

In the early morning hours of Sunday, June 12, a senseless act of violence in a nightclub in Orlando has left us horrified, angry, frightened and confused. Hate and terror were targeted at our nation’s LGBT community and the wounds touch us all. Very rarely can such violence be explained in any manner that makes sense to rational people.

Our thoughts and prayers go out to all those affected by the shooting in one of America’s cities visited by tourists from around the world. We offer a prayer for the families whose lives are forever changed. We stand in support of the LGBT community and all those who feel marginalized by the evils of racism and discrimination.

Upon reflection of Sunday’s tragic event, we are reminded of the courage and skill of our nation’s first responders and law enforcement. We are touched by the acts of kindness by many who came to the aid of the seriously injured and frightened. We are moved by the lines of fellow citizens gathering to donate blood or joining together to lift their voices in support of love, equality and democracy. We are also reminded of the resilience of the American people. The Twenty-first Century seems to reflect an increasingly complex society but our humanity has not changed.

Today, many of our nation’s hospice and palliative care professionals will care for someone who will end his or her life’s journey. They will be there for them, and comfort their families as they say a final goodbye and grieve their loss. They will care for them with the professionalism and compassion that are hallmarks of hospice and palliative care; the mission to serve others will not be diminished or hampered.

Many providers will make the services of bereavement professionals and grief counselors available to the broader community that will need a place to explore the wide range of emotions and loss they are feeling. It is important that hospices remind their communities that they are an important resource with the skills to help those who are grieving and coping with loss.

Yesterday’s events affect us. We should allow ourselves time to process what we are seeing and hearing via ongoing newscasts. We are reminded to be attentive to our children and monitor what they may be seeing on the news or on the Internet. Let us also support those heroes who respond in such emergencies and lend an ear to our friends and neighbors who may need to share their fears or concerns without judgment – particularly from our loved ones and neighbors who are part of the LGBT community.

It’s also an important time to take an extra moment to tell those near to us that we love them. 

National Hospice and Palliative Care Organization
Alexandria, VA

Friday, June 3, 2016

Using Metrics for Marketing

If I could offer one key to getting your foot in the door with potential partners and referral sources, it would be, “know your metrics.” Don’t just tell the local health system that you provide great hospice care and your patients love you. Tell them that you can prevent those patients from bouncing back into the hospital or ER. And then prove it.

You can use your own patients’ histories to make the case. Gather aggregate statistics on your patients’ hospital admissions or ED visits in the period prior to hospice admission. You may cover the 30, 60 or 90 days prior to the hospice admit; then look at their care patterns afterwards. Be sure you know what percentage of your hospice patients are admitted to a hospital while on service and break it out by diagnosis, so you look closely at those diagnoses that we know are highly likely to run the risk of readmission. In particular, check hospital utilization for patients admitted to hospice after hospital admissions for COPD, CHF or stroke. 

One key measure that will pique the interest of ACO referral sources is the overall cost of care for your patients. ACO shared savings targets depend on reducing the total cost of care for the lives assigned to the ACO, regardless of where that care is received. If you can demonstrate a mean Medicare payment per admission that’s lower than your competitors, you might consider sharing that information with the leadership of the ACO with whom you seek preferred status. You may be able to get that comparative data from your state survey of hospices, or from one of the national hospice data analytics firms that gathers Medicare claims. 

Consider external sources of data as well. If your relationship with the local health system permits, you may be able to run a cooperative study, drawing from their inpatient data to find out which diagnoses and which patients are creating avoidable costs to the system. And don’t forget to check the CMS consumer site, Hospital Compare. That site shows rates of readmission for several key diagnoses, and how well each individual hospital is doing at meeting targets for avoidable readmits. 

Be imaginative and try to see through the lens of your referral partners’ needs. If hospice and palliative providers are truly to take a seat at the table, we need be seen as the problem solvers we are.

Sue Lyn Schramm, MA
Director, Consulting Services, NHPCO

See the previous NHPCO Edge Blog article, "The Gentle Art of Teaching Hospital CEOs."

Wednesday, June 1, 2016

Too many advanced cancer patients lack basic understanding about their disease

Just 5% of terminally ill cancer patients understood their prognosis, researchers say. 

Only a small consortium of advanced cancer patients were able to show that they could identify and fully understand their prognosis according to a study led by faculty members from Memorial Sloan Kettering and Weill Cornell Medicine, which aimed to uncover the influence of prognostic discussions on the accuracy of illness understanding.

The open access study, published in the Journal of Clinical Oncology, compared patients’ understanding of their illness before and after scans that staged their cancer, and before and after discussing results with their oncologist. Before the restaging scan visit, just nine (5%) of 178 patients acknowledged being at the end stage of incurable cancer with just months to live.

Find out what our contributing faculty members at the Center for Research on End-of-Life Care at Weill Cornell Medical College had to say about this issue.

Wednesday, May 25, 2016

Be a Part of the End-of-Life Challenge on OpenIDEO

Recently, a global effort kicked off to start radical conversations around the end of life experience. It’s launching on OpenIDEO (an open innovation platform) in partnership with Sutter Health and the Helix Centre and will lead a global community through collaborating with each other to design new ideas for enhancing the personal experience of death and dying.

The question being asked: How might we reimagine the end-of-life experience for ourselves and our loved ones? 

All people who have thought about this important issue are encouraged to participate in this global movement. The Inspiration phase of the challenge is now open for stories and the challenge will be collecting new posts.

This OpenIDEO challenge is an inspiring place to collaborate with people from around the world on this topic, collectively improve new ideas, get feedback from experts and potentially get a fresh idea off the ground. It’s also a place to boost your creative problem solving skills.

Learn more and participate in the End-of-Life Challenge.

Thursday, May 19, 2016

Early Palliative Care Provides Important Benefits for Family Caregivers of Patients with Cancer reports ASCO

A press release from the American Society of Clinical Oncology reports on this new study.

“Caregivers provide critical support for patients with cancer, but it can take a heavy toll. This study shows that early palliative care, although designed for and directed at patients, can also help ease the burden on their caregivers,” said ASCO President Julie M. Vose, MD, MBA, FASCO, ASCO President. “This insight contributes to the large and growing body of evidence supporting early palliative care for patients with advanced cancers.”

A randomized clinical trial found that introducing palliative care shortly after a cancer diagnosis results in better quality of life and fewer depression symptoms for family caregivers. According to the authors, the study is the first to show that early palliative care alone for a patient with cancer can have a strong impact on family caregivers. The study was featured in a press briefing May 18, 2016 and will be presented at the 2016 American Society of Clinical Oncology (ASCO) Annual Meeting in Chicago.

“This study suggests that early palliative care creates a powerful positive feedback loop in families facing cancer,” said lead study author Areej El-Jawahri, MD, Director of Bone Marrow Transplant Survivorship Program at Massachusetts General Hospital Cancer Center. “While patients receive a direct benefit from early palliative care, their caregivers experience a positive downstream effect, which may make it easier for them to care for their loved ones.”

Read the full ASCO press release
View the full abstract
The study will be presented at the 2016 American Society of Clinical Oncology Annual Meeting.

Tuesday, May 10, 2016

The Gentle Art of Teaching Hospital CEOs

One of the challenges for hospice and palliative leaders has always been that their services were seen as a small part of the healthcare continuum. Over and over, I’ve had hospice CEOs and administrators tell me their greatest frustration was getting the time of day from hospital and health system execs.
Lately, however, I’m not hearing that as much. Instead, I hear clients and friends telling me their local system seems interested in post-acute care in a new way. In January of this year, the Society for Healthcare Strategy & Market Development published results from a survey of hospital and health system executives, CEOs and CFOs, mostly. They were asked, “How likely is it that by 2021, the proportion of your hospital or health system’s expenditures devoted to post-acute care capabilities (palliative care, hospice, or skilled nursing) will increase?” Fully 92% of them said it was Likely. 54% of them even said “Very Likely.”
The reason for this new attention to post-acute care is that new payment incentives are strongly encouraging acute care providers to care about what happens after patients are discharged from the hospital more than ever before. This hasn’t always been the case. Jeff Goldsmith, the well-known healthcare futurist, recently wrote about this issue: “Traditionally, the hospital’s responsibility ended abruptly upon discharge. In candor, the discharge process often was not focused on patient outcomes. In many institutions, the main focus was on clearing the bed and making sure the patient had a safe ride home.”
Now however, inattention to what happens immediately after an acute care episode can cost the hospital, health system or ACO money. If the patient comes back as a re-admission or Emergency Department visitor, that’s bad, not only for the patient, but also for the at-risk provider’s bottom line.
Cost avoidance is the name of the game, and post-acute care is finally getting its due as a key component in improving outcomes and reducing costs. Unfortunately, that doesn’t always mean that the hospital CEOs know clearly what they want or need from hospice. Nor does it mean they always have a good understanding of why hospices can make vital partners in a health system’s efforts to reduce costs of care.
Hospice leaders may find themselves in the position of (gently) helping their local hospitals and health systems to understand the new imperatives of managing costs when revenue is at risk. After all, managing patient costs on a fixed payment is something that the hospice industry has been doing since 1983.
This post is a preview from a longer article on working with ACOs and hospitals that will appear in the Summer edition of NHPCO’s Newsline out June 15. 

Sue Lyn Schramm, MA
Director, Consulting Services, NHPCO