How Reimbursement Is Changing For Palliative Care - MACRA
by Stacie Sinclair(Register for the free webinar here)There is no disputing that recent events mean a huge shift in the direction of health care in the coming years. Although we ’re learning more each day about what programs will stay and what will go, there remains tremendous uncertainty that only time will clarify. Yet in this period of transition, there is at least one major program that the nation’s best health policy minds agree is here to stay: MACRA’s QPP!WHAT DO THOSE CRAZY ACRONYMS MEAN?TheMedicare Access and Children ’s Health Insurance Program (CHIP) Reauthorization Act of 2015 (MACRA) is a bipartisan la...
Source: Pallimed: A Hospice and Palliative Medicine Blog - November 19, 2016 Category: Palliative Care Tags: AAHPM CAPC CMS HPNA macra medicare mips nhpco palliative care profession sinclair Source Type: blogs

FAQ for New Hospice Volunteers: 15 Simple Questions You're Afraid to Ask
By Lizzy MilesBefore I was a hospice social worker, I was a volunteer. I was so nervous to visit my first patient. Over time, I became more comfortable. Through the course of switching careers from volunteer to social worker, I attended volunteer training at several organizations. There is a lot of really good information provided, but sometimes hospice staff forget what it ' s like to be NEW. These are the questions I had when I first started. Once I gained experience, and went to school for further training, I decided it might be helpful to write out the answers for others who are just embarking on their hospice journey....
Source: Pallimed: A Hospice and Palliative Medicine Blog - November 16, 2016 Category: Palliative Care Tags: conversation hospice lizzy lizzy miles palliative volunteer Source Type: blogs

A Collaborative Journey to Transform Advanced Illness Care
by Amy K. ShawThe healthcare system is undergoing a fundamental shift from care geared primarily toward medical or clinical needs to care that addresses the needs of the person as a whole. The forces driving this change are two-fold. First, a consumer-focused movement is gaining increased momentum amidst widespread recognition that better patient engagement improves healthcare quality and lowers costs. Second, significant changes in national policy require ongoing monitoring and measurement to assure progress towards the goal of person-centered care for those with advanced illness. In January 2016, the Centers for Medicare...
Source: Pallimed: A Hospice and Palliative Medicine Blog - November 15, 2016 Category: Palliative Care Tags: #hpm CTAC hpmchat NQF Source Type: blogs

Symptoms of Cancer May Include Fatigue, Unexplained Weight Loss, Fever and Foreclosure
by Bridget BlitzAs a palliative care social worker, I provide home visits to patients and families to explore how they are coping with complex medical issues, which resources they need, how we might add services that could reduce caregiver strain, and talk to them about their goals of care and about their wishes for the life they have left. Startling to me, within these discussions, is the depth of fear and anxiety about finances that leave these individuals struck with more than a horrible illness. They now have to absorb the real possibility of being without a permanent home in addition to adapting to new treatments, sym...
Source: Pallimed: A Hospice and Palliative Medicine Blog - November 14, 2016 Category: Palliative Care Tags: bankruptcy financial social work social worker Source Type: blogs

The Illusion of Impermeability
by Laura PatelAs I sat in my hospice interdisciplinary group meeting, reviewing the many patients who have died in the past two weeks as well as our new patients, there was a slight break in the discussion. Being ever the multitasker, Iclicked on a NY Times article I have been meaning to read and scanned the first two sentences: “When my husband died from cancer last March at age 37, I was so grief-stricken I could barely sleep. One afternoon, I visited his grave — in a field high in the Santa Cruz Mountains, overlooking the Pacific Ocean — and lay on top of it. I slept more soundly than I had in weeks.” Suddenly, ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - November 13, 2016 Category: Palliative Care Tags: kalanithi patel Source Type: blogs

The Doctor and the Rabbi: A Healing Conversation About End-of-Life Care
by Rev. Rosemary Lloyd“It routinely makes me hurt inside when patients and family are admitted to an ICU, as most have rarely if ever considered what care they truly want, or not. It is heart breaking to try and help them assimilate it all, and all too frequently decisions are left for families, with left over feelings that may linger for years.”This is what Dr. Jeff Dichter, an ICU Medical Director wrote gratefully to Rabbi Esther Adler of Mount Zion Temple in Saint Paul, Minnesota afterher sermon on Yom Kippur, a major holy day in the Jewish calendar.“As health care professionals,” he continued, “we sometimes w...
Source: Pallimed: A Hospice and Palliative Medicine Blog - November 12, 2016 Category: Palliative Care Tags: chaplain lloyd spiritual spirituality spirituality/religion Source Type: blogs

10 Take Home Lessons from the CAPC 2016 National Seminar
By Laura PatelI was fortunate to attend the 2016 CAPC conference in Orlando. Below are some of the most notable pearls I will be taking home with me.1. Palliative care is about the relief of suffering. This requires a multifaceted approach and is something that case management based or disease management based programs do not address.2. Palliative care clinicians are uniquely situated to comment on and participate in healthcare transformation. We need to be advocates and “rabble rousers” (per Dr. Martha Twaddle) to encourage our healthcare system to embrace a focus on prevention and well-being, not only on disease.3. D...
Source: Pallimed: A Hospice and Palliative Medicine Blog - November 2, 2016 Category: Palliative Care Tags: CAPC conference education patel Source Type: blogs

Engaging The Communities We Serve
by Tacy Silverberg-UrianA cultural transformation of our perspectives on dying and end of life (EOL) care is slowly beginning to take shape. There has been a significant rise in the number of mortality- and EOL-related newspaper articles, books, and documentaries. There has also been a grassroots public campaign called the Conversation Project, which is focused on initiating conversations on dying. The federal government, particularly the centers of Medicare and Medicaid, have proposed various EOL initiatives. In 2014 the IOM (Institute on Medicine) laid out a comprehensive position paper entitled “Dying in America: Impr...
Source: Pallimed: A Hospice and Palliative Medicine Blog - November 2, 2016 Category: Palliative Care Tags: Atul Gawande Being Mortal community death death cafe death over dinner death/dying five wishes Silverberg-Urian van Meines Source Type: blogs

Cases: Use of Steroids as Adjuvants for Pain Management
Conclusion:Although there is no definitive, absolute proof that use of dexamethasone as an adjuvant agent for symptom management does not confer a potential increased risk of infection, we do have literature indicating that steroids are used to help manage and treat certain infections, and that there has not been evidence of increased new infections when used in a single dose post-operatively. The clinical take away here is that it okay to consider the use of a steroid, especially in a low dose for a short period of time, in managing pain of an inflammatory etiology (such as pleurisy), and when compared to the potential ri...
Source: Pallimed: A Hospice and Palliative Medicine Blog - October 31, 2016 Category: Palliative Care Tags: cancer hematology opioids pain riegel steroids Source Type: blogs

Building Faith in the Power of The Conversation
by Rev. Rosemary LloydWhen the senior minister of Old South Church in Boston, Massachusetts, Rev. Dr. Nancy Taylor, began her sermon one Sunday morning she raised a lot of eyebrows.“Mary,” she began, “you are going to die.” She started pointing out people in the church and telling them that they are going to die. Young and old, men and women, she called out congregants by name and reminded them that death is not a dirty secret; it’s a fact of life. Her sermon continu ed, weaving in humor to diffuse the tension and ultimately generating chuckles and nods of understanding from the crowd.“These days, people often ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - October 26, 2016 Category: Palliative Care Tags: chaplain communication community conversation project lloyd spirituality spirituality/religion Source Type: blogs

Palliative Care for Caregiver Distress
by Sujin Ann-YiAccording to theCaregiving in the US 2015 research report (PDF) conducted by the National Alliance for Caregiving (NAC) and American Association of Retired Persons (AARP), 43.5 million adults in the US have provided uncompensated care to an adult or a child in the past year. The same report found caregivers provide on average 24.4 hours per week of support to their family member. Spouses were found to provide on average 44.6 hours per week and almost 25% of caregivers provide 41 hours per week.Caregivers refers to family members who provide ongoing continuous care, typically without any compensation, fo...
Source: Pallimed: A Hospice and Palliative Medicine Blog - October 24, 2016 Category: Palliative Care Tags: ann-yi anxiety cancer caregiving depression tweetchat twitter Source Type: blogs

" Incompatible With Life, " Compatible With Love: Perinatal Hospice and Palliative Care
by Amy KuebelbeckIt ' s a relatively new phenomenon: With advances in prenatal testing, some parents who are happily anticipating the birth of their baby instead receive the devastating news that their baby is expected to die.Then what? Often, the default recommendation is to terminate the pregnancy and try again. A growing number of parents prefer to continue their pregnancies and embrace their babies ' lives for however long they might last, even if that time is only before birth. But a distressing number of these parents report feeling abandoned by their caregivers and even chastised and criticized for choosing this pat...
Source: Pallimed: A Hospice and Palliative Medicine Blog - October 17, 2016 Category: Palliative Care Tags: hospice pediatric PedPC perinatal Source Type: blogs

Servant Leadership in Palliative Care
by Beth Fahlberg PhD, RN, CHPN and Robert Toomey, EdD, MALeaders are needed in palliative care who can provide the direction for current and future development. We recently wrote an article on Servant Leadership as a model for emerging Nurse leaders, which got us thinking about how Servant Leadership is a model that is also fitting for palliative care. There are many different models of leadership, yet the Servant Leadership model is particularly appropriate for palliative care.Characteristics of servant leaders include: the ability to listen, empathy, healing, stewardship, commitment to the growth of others, and being ski...
Source: Pallimed: A Hospice and Palliative Medicine Blog - October 12, 2016 Category: Palliative Care Tags: fahlberg leadership The profession toomey tweetchat twitter Source Type: blogs

Five Tips for Effective Quality Improvement in Palliative Care (#3 will blow you away)
by Arif KamalApologies for the “clickbait” title to the blog post; scouring the internet it seems that hyperbole works to get readers’ attention, certainly among entertainment sites and maybe increasingly within presidential politics. But it seems I had little choice; the fifth word of my title is “Quality”, which exci tes very few people. Bear with me, I promise this will get good.Quality improvement is critical for palliative care organizations to build and sustain success within their clinical missions. Those who are watching and evaluating us, including patients, caregivers, health systems, regulators, and pa...
Source: Pallimed: A Hospice and Palliative Medicine Blog - October 5, 2016 Category: Palliative Care Tags: kamal quality research issues twitter Source Type: blogs

Mindfully Conquering Burnout and Cultivating Self-Compassion
by Robert GerardSome thoughts on a transformative program recently completed atUpaya Zen CenterI stared atthis Tweet because I could not fathom how everybody could be this happy.Everyone appeared to sparkle with joy, and I felt an astonishing resentment and discontent by what they must have accomplished. This Tweet rapidly crystallized an awareness that I had not been taking care of myself. I feared my capacity to feel happiness for others had vanished for keeps. There was no denying it was a sign ofburnout. I had become physically tired at the end of the work day. Time and again I was emotionally drained and needed to sit...
Source: Pallimed: A Hospice and Palliative Medicine Blog - September 29, 2016 Category: Palliative Care Source Type: blogs