Recent News on End-Of-Life Care s1

______HOSPICE NEWS NETWORK Recent News On End-of-Life Care

Volume 17, Number 19 May 14, 2013 A Service of State Hospice Organizations ______

HASTINGS CENTER PUBLISHES UPDATED GUIDELINES FOR EOL CARE

The Hastings Center Guidelines for Decisions on Life-Sustaining Treatment and Care Near the End of Life has been released in a revised and expanded second edition, published by Oxford University Press. This new release significantly amplifies the original, comprehensive guidelines that were groundbreaking when first published in 1987.

The original edition of these guidelines proved foundational for the development of ethical and legal frameworks concerning medical decision-making in the United States. Crucially, the report “was cited in the U.S. Supreme Court’s 1990 decision in the case of Nancy Beth Cruzan, which established the Constitutional right of patients to refuse life-sustaining medical treatments and the authority of surrogate decision-makers for patients without decision-making capacity.”

The newly revised Guidelines represent the consensus of a Hastings Center project work group, comprised of leaders in a variety of disciplines including medicine, law and nursing. The work group sought to continue the standard-setting work of the original project, bringing the volume up to date with broad synthesis of “research, policy, and innovation in quality improvement, patient safety, and palliative care that have emerged in the decades since the original publication.”

Recognizing that the Guidelines should be useful to practitioners in the field, the volume is structured for easy reference in a clinical environment. It provides practical advice on communication and collaboration between various members of interdisciplinary teams. To facilitate the widest possible access to the document, Guidelines is being made available both in print and electronic formats.

Guidelines was produced by a team of co-authors. The first is Nancy Berlinger, a research scholar at The Hastings Center. She served as director for the project that produced this new publication. Bruce Jennings is a Hastings Center Fellow and director of bioethics at the Center for Humans and Nature. In 1987, he helped to co-author the original Guidelines. The third contributing editor, Susan M. Wolf, is also a Hastings Center Fellow. She is the McKnight Presidential Professor of Law, Medicine & Public Policy at the University of Minnesota. She directed the original guidelines project and was the principal author of the first edition.

1 To learn more about this newly released resource, see the Guidelines website below. The website features a variety of additional resources, including excerpts from the book, a searchable index, an executive summary, and advance praise for the book. (www.HastingsCenterGuidelines.org)

HOSPICE NOTES

* OIG is targeting misuse of inpatient care by hospices, explaining that unusual billing patterns warrant a broad investigation. The HHS Office of Inspector General found that “hospices with their own inpatients units provided general inpatient care (GIP) to more Medicare beneficiaries, and for longer periods of time, than hospices without such facilities.” The OIG indicates that these findings “raise several questions about GIP,” and that further review will be necessary to ensure that appropriate levels of care are being administered. (Fierce Healthcare, 5/7, www.fiercehealthcare.com/story/oig-targets-hospice-misuse-general-inpatient-care/2013-05- 07; Modern Health Care, 5/6, www.modernhealthcare.com/article/20130506/NEWS/305069968/unusual-billing-patterns-spur- probe-of-inpatient-hospice-care)

* Starting July 1, the state of Wyoming will cover half of the room and board expenses of Medicaid patients in hospice care facilities. Medicaid currently covers the cost of hospice medical expenses, but does not provide help to cover food and housing costs. (Star Tribune, 5/10, trib.com/news/state-and-regional/new-law-eases-access-to-hospice-care-in- wyoming/article_a296bb7a-c725-5624-8a18-8398068752f5.html)

* Workers at the new Addeo Hospice Residence, New York City’s first free-standing hospice home, share about their experience of serving those at the end of life. (NY Daily News, 5/4, www.nydailynews.com/new-york/nyc-free-standing-hospice-article-1.1334282? localLinksEnabled=false)

* Medicare Hospice Payment Reform: Hospice Study Technical Report is a report commissioned by CMS. The report, dated 4/24/13, is available online. According to the report, “CMS contracted with Abt Associates Inc., teaming with Social and Scientific Systems, Inc. and the Brown University Center for Gerontology and Healthcare Research, to conduct comprehensive data analyses.” To read the entire report, go to cms.gov and search for HHSM- 502005-00018I in order to reach the link to the PDF of the study. (CMS.gov)

* Medicare is lagging in a project that would expand hospice, reports Kaiser Health News. “Despite a three-year-old order from Congress, Medicare has yet to begin an experiment to expand hospice services to allow beneficiaries to continue potentially lifesaving treatments to see if it would save money while improving the patients’ quality of life.” “The demonstration project would eliminate one major reason that people are reluctant to take up Medicare's hospice benefit: they have to first agree to forgo curative treatments such as chemotherapy.” (Kaiser Health News, 5/9, www.kaiserhealthnews.org/Stories/2013/May/09/Medicare-delays-experiment-on- hospice-and-curative-care.aspx)

2 * Hospice of the Bluegrass announced layoffs related to federal sequestration and to patients’ late entry into hospice care. The Kentucky hospice will reduce its staff by 2.5 percent - a total of 16 positions - as the result of “significant cuts in [federal] reimbursements.” (Business Lexington, 5/3, bizlex.com/2013/05/hospice-of-the-bluegrass-announces-sequester-related- layoffs/)

END-OF-LIFE NOTES

* An article published in The American Journal of Public Health argues that end-of-life care issues must become an integral part of the US public health agenda. Dan Morhaim, MD, and Keshia Pollack, PhD, observe, “The low rate of completion of advance directives in the minority population can be identified as another health care disparity.” (Health Canal, 5/8, www.healthcanal.com/public-health-safety/38428-advance-directives-manage-end-of-life-care- issues-and-reduce-end-of-life-medical-costs.html)

* Unfinished Business, a new play by Rod Lathim, explores issues of death and dying. The play was written to dramatize the playwright’s “own experience of receiving the guidance he needed at this very difficult time” when his mother was dying. (Santa Barbara Independent, 5/8, www.independent.com/news/2013/may/08/emunfinished-businessem-explores-end-life-issues/)

* Jeanne Dennis, senior vice president for VNSNY Hospice Care, shares insights from the perspective of an end-of-life care nurse. Writing for The Huffington Post, Dennis highlights “the special training, ability and insights that distinguish hospice nurses in truly remarkable ways.” (The Huffington Post, 5/6, www.huffingtonpost.com/jeanne-dennis/end-of-life- care_b_3210132.html)

* A newly released study demonstrates that terminally ill patients who are supported by religious communities are less likely to receive hospice care, opting instead for more aggressive treatments - “particularly among racial/ethnic minority and high religious coping patients.” The results of the study also indicate that “among patients well-supported by religious communities, receiving spiritual support from the medical team was associated with higher rates of hospice use... fewer aggressive treatments... [and] fewer ICU deaths.” (News Medical, 5/7, www.news-medical.net/news/20130507/Terminally-ill-patients-supported-by- religious-communities-receive-more-intensive-EoL-medical-care.aspx; MedPageToday, 5/6, www.medpagetoday.com/HematologyOncology/OtherCancers/38923)

* Venture capital group Jumpstart, Inc., is investing $250,000 in eFuneral, “a comprehensive end-of-life planning resource.” The company explains their view that eFuneral is “a unique and valuable resource,” positioned for “significant growth.” eFuneral will use the investment funds to increase sales, promotion and digital marketing efforts. (Jumpstart, Inc., 5/7, www.jumpstartinc.org/aboutus/pressroom/pressreleases/2013/JumpStart-Invests-250000-in- eFuneral.aspx)

PALLIATIVE CARE NOTES

3 * A new study reveals that positive steps can be taken within clinical settings to increase end-of-life discussions and improve overall care. “A multifaceted intervention of a physician order form, educational sessions, and palliative care consult service led to an improvement in documentation of end-of-life discussions and was associated with an increase in such discussions and less burdensome treatments.” (PubMed, 4/29, www.ncbi.nlm.nih.gov/pubmed/23630054)

* Can film screenings raise awareness of palliative care issues? Physician Paul Tatum believes so. Writing for Pallimed, Tatum details the work of the American Academy of Hospice and Palliative Medicine through their Shaping the Future Campaign. Tatum advocates for the use of documentary film as a way of expanding public consciousness around palliative care issues. (Pallimed, 5/1, www.pallimed.org/2013/05/raising-palliative-care-awareness.html)

* Pallimed highlights a recent segment that aired on NPR’s Wait, Wait... Don’t Tell Me! The program explores evidence that Tylenol (acetaminophen) can reduce stress and anxiety about death. To listen to the original radio segment, check out this link: www.npr.org/2013/05/04/181034258/bluff-the-listener (Pallimed, 5/5, http://www.pallimed.org/2013/05/relief-from-death-anxiety-in-your.html)

POLICY NOTES

* Whistleblower attorneys are reaching out to those who might help expose hospice Medicare fraud. One online site notes recent activity and reaches out to whistleblowers, saying, “If you are a hospice employee with knowledge that your employer is committing fraud against government healthcare programs such as Medicare and Medicaid, you need an experienced hospice fraud whistleblower attorney to represent you.” (www.whistleblower- claims.com/hospice-care-fraud.php)

* The Department of Veterans Affairs has issued a rule called Payment for Home Health Services and Hospice Care to Non-VA Providers. The VA “amends its regulations concerning the billing methodology for non-VA providers of home health services and hospice care... This rulemaking will only affect home health and hospice care providers who do not have existing negotiated contracts with VA.” The full policy is available online: www.gpo.gov/fdsys/pkg/FR-2013-05- 06/pdf/2013-10694.pdf (US Fed News, 5/8)

* In Maryland, the Governor has approved the Hospitals - Establishment of Palliative Care Pilot Programs, a bill that passed unanimously by both House and Senate. To view the text of the bill, see: mgaleg.maryland.gov/webmga/frmMain.aspx? pid=billpage&stab=02&id=hb0581&tab=subject3&ys=2013RS

* In Montana, the debate over physician-assisted suicide has moved back into the courtroom. The state legislature failed to clarify whether the practice is specifically legal or illegal, but lawsuits seek to obtain such clarification through the court system. (Billings Gazette, 5/8, billingsgazette.com/news/state-and- regional/montana/fight-over-assisted-suicide-moves-back-to-court/article_7985baad-

4 87a0-592a-b6dd-187073a4c47f.html; San Fransisco Chronicle, 5/8, www.sfgate.com/news/article/Fight-over-assisted-suicide-moves-back-to-court- 4499679.php)

* Vermont’s Senate has approved a bill that would allow terminally ill residents to have access to treatments that would hasten death. The bill, which passed with a vote of 17-13, is being hailed as a “compromise,” advancing a slightly modified, less restrictive, form of the original bill. (USA Today, 5/9, www.usatoday.com/story/news/politics/2013/05/09/vermont-physician-assisted- death-bill/2146617/)

* The governor of Michigan has declared May 12-18, 2013 to be Michigan Hospice and Palliative Care Week. For more details, see the governor’s website: www.michigan.gov/snyder/0,4668,7-277-57577_59874-302192--,00.html

ADVANCE CARE PLANNING NOTES

* US News MONEY hosts a Google Chat discussing The Conversation Project with Ellen Goodman, co-founder of the Project; Harvey Freishtat, a director of the Project; and Ira Byock, a palliative care physician and director of palliative medicine at Darmouth-Hitchcock Medical Center. (US News MONEY, 5/8, money.usnews.com/money/blogs/the-best-life/2013/05/08/how- to-talk-to-parents-about-their-end-of-life-wishes)

* John Loughnane, medical director for the Commonwealth Care Alliance Life Choices Palliative Program, writes a letter to the editor of MetroWest Daily News, in which he highlights advance care planning issues and the importance of The Conversation Project. (MetroWest Daily News, 5/?, www.metrowestdailynews.com/opinion/x522266494/Loughnane- He-died-of-a-Tuesday?zc_p=1)

Thank you to Don Pendley for contributions.

Glatfelter Insurance Group is the national sponsor of Hospice News Network for 2013. Glatfelter Insurance Group provides property and liability insurance for hospices and home healthcare agencies through their Hospice and Community Care Insurance Services division. Ask your insurance agent to visit their website at www.hccis.com .

Hospice News Network is published 45-47 times a year by a consortium of state hospice organizations. Copyright, 2013. All rights reserved to HNN subscribers, who may distribute HNN, in whole or part, to provider members of the subscribers’ state organizations. If readers need further information, they should consult the original source or call their state association office. HNN exists to provide summaries of local, state and national news coverage of issues that are of interest to hospice leaders. HNN disclaims all liability for validity of the information. The information in HNN is compiled from numerous sources and people who access information from HNN should also research original sources. The information in HNN is not exhaustive and HNN makes no warranty as to the reliability, accuracy, timeliness, usefulness or completeness of the information. HNN does not and cannot research the communications and materials shared and is not responsible for the content. If any reader feels that the original source is not accurate, HNN welcomes letters to the editor that may be shared with HNN readers. The views and opinions expressed by HNN articles and notes are not intended to and do not necessarily reflect views and opinions of HNN, the editor, or contributors. Only subscribing state hospice organizations have rights to distribute HNN and all subscribers understand and agree to the terms stated here.