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Tell CMS the Payment Proposals Will Hurt Patients with Serious Illness
by Phil RodgersSubmit comments this weekend! Deadline: Monday, Sep 10, 11:59 PM ETRegular Pallimed readers willremember Amy Davis ’ excellent post regardingCMS ’ recent proposed rule updating the Medicare Physician Fee Schedule and Quality Payment Program for 2019. (See thisCMS Fact Sheet to learn more). In this rule, the agency proposes historically bold changes to outpatient evaluation and management (E/M) documentation requirements and payments, among many other substantial changes in the fee-for-service Medicare program.CMS says these proposed changes are designed to " increase the amount of time that doctors and o...
Source: Pallimed: A Hospice and Palliative Medicine Blog - September 7, 2018 Category: Palliative Care Tags: medicare outpatient rodgers The profession Source Type: blogs

Lay Health Workers Increase Documentation of Care Preferences
by Ben SkochReview of Effect of a Lay Health Worker Intervention on Goals-of-Care Documentation and on Health Care Use, Costs, and Satisfaction Among Patients with Cancer. A Randomized Clinical Trial. Patel MI, Sundaram V, Desai M, et al. JAMA Oncology July 2018. doi:10.1001/jamaoncol.2018.2446I ’m sure many, if not most health professionals who have spent time around an oncology unit have encountered patients receiving care in the late stages of their disease and had the thought, “Is this really helping?” Or possibly, “Has anyone asked this patient how they feel about this treatmen t?” As a palliative ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - September 5, 2018 Category: Palliative Care Tags: advance care planning journal article pallimed writing group skoch Source Type: blogs

Book Review: My Father ’s Wake: How the Irish teach us to live, love and die by Kevin Toolis
by Rebecca Gagne Henderson (@RebeccaGagne)The tone and theme of this book is set with the profound and moving epigraph from the Iliad:“The generations of men are like generations of leaves. The wind scatters one year’s leaves on to the earth, but when Spring comes the luxuriant forest produces other leaves; so it is with generations of men, one grows as the other comes to an end”. Iliad 6 --145The book is titledMy Father ’s Wake: How the Irish teach us to live, love and die. Mr. Toolis is a writer, journalist and award-winning filmmaker and documentarian. His family has lived for two centuries in a small seaside vi...
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 31, 2018 Category: Palliative Care Tags: book book review culture diversity gagne henderson Source Type: blogs

Evidence-Based Prognostication
by Christian Sinclair (@ctsinclair)We are prognosticating beings. It is how we survive. Many everyday decisions begin with an estimation of likely future outcomes. If my first clinic appointment is at 9:15am, and my drive from the hospital to the clinic usually takes 25 minutes, then I need to leave by 8:50am at the latest to give myself time to spare for bad traffic light timing, lack of a good parking spot or some other problem that may delay my arrival. I make my estimates, and go with the safest choice. I could go with my gut and my experience or I could use Waze, an app where I can select where I am leaving from, wher...
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 27, 2018 Category: Palliative Care Tags: hpmchat journal article prognosis research sinclair tweetchat twitter Source Type: blogs

To Resuscitate or Not to Resuscitate
by Rebecca Omlor (@BeccaOm15)The code bell goes off overhead calling for a rapid attempt to try to bring a patient back to life. Who is on the receiving end? Is it a frail older adult with dementia, a patient with multiple medical problems, or an otherwise healthy adult who recently underwent a cardiac catheterization for a myocardial infarction?If this was the scenario in 2018, a team would rush to that patient and begin cardiopulmonary resuscitation (CPR) along with advanced cardiac life support (ACLS) including the use of medications and external defibrillation, if indicated, to attempt to revive the patient. While we p...
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 25, 2018 Category: Palliative Care Tags: CPR omlor research resuscitation Source Type: blogs

Death Notification as Behavior Modification: Let's think this through
by Ben Skoch (@skochb)Opioid Problem. Opioid Epidemic. Opioid Crisis.Call it what you will (as long as you don ’t use the word narcotic, butthat ’s another article), but the United States has a real issue with opioids right now. It has been much talked about, publicized, criticized, politicized, has left some people ostracized, to a point where the concern has become supersized. Six years ago,a reportstated enough opioid prescriptions were written for every adult in the US to have a bottle of pills, about 259 million. Couple that with thereport from the CDC that over 42,000 people died from opioid (illicit and prescrib...
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 24, 2018 Category: Palliative Care Tags: behavior change burnout california journal article opioids research skoch The profession Source Type: blogs

Talking it Like it is: Advice from a HPM Fellow to all the New Interns
by Christine BridgesThe hallways are full again after a short June reprieve. Starched white coats, cleaner than it ever seemed possible bustle through the hallways, making up in speed what they lack in direction. They fill each space with eager anticipation. It is almost palpable. It is the scent of July. Each furtive glance at the clipboard in the elevator fills me with longing to tell them the advice I wish had been passed out with my first pager.The biggest challenge ahead of you will be communication. Over the next 3-7 years more often than relieving tension pneumothoraxes, performing thoracenteses, or placing art line...
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 22, 2018 Category: Palliative Care Tags: bridges communication intern residency The profession Source Type: blogs

Does Colace (docusate) Work For Constipation? No!
This study was highlighted in theGeriPal Top 25 articles in HPM.- Ed.)Randomized, Double-Blind, Placebo-Controlled Trial of Oral Docusate in the Management of Constipation in Hospice Patients. Tarumi et al. Journal of Pain and Symptom Management, 2013: 45(1), 2-13.Palliative care fellows may wonder about their attendings fixation on bowel movements. It may be because we do not ask medical students to disimpact patients any more or because, given the lack of ambulatory care many residents do, they do not see it as a big deal (Constipation a GREAT topic for those of us who like puns and dad jokes).For patients, how...
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 20, 2018 Category: Palliative Care Tags: arnold constipation docusate geripal top 25 pallimed writing group senna Source Type: blogs

Introducing the Pallimed Writers' Group
by Christian Sinclair (@ctsinclair)We used to publish a lot more article reviews here on Pallimed. Sometimes the analysis would be quite deep and sometimes we would just lump together a while bunch of snippets from key articles. I have been keeping an ever-growing list of articles I would love to write up for the site*, but never seemed to have the time to get to them, and then new ones would come out, that I would want to write about, but they too would just get added to the list. At the end of the year, I would look back on key articles for our field and be pretty bummed out that I never got anything published here about...
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 20, 2018 Category: Palliative Care Tags: meta sinclair Source Type: blogs

Professional Development for the Whole Team
by Karla Washington (@comokarwash)I entered graduate social work education in 1998. St. Louis Cardinals first baseman Mark McGwire broke the single-season home run record that year. Hearings were held regarding the impeachment of President Bill Clinton, and C éline Dion released a duet with R. Kelly, forming a collaboration that probably sounds preposterous to most people younger than 25. On the technology front, social media as we know it today was years away (Mark Zuckerberg was only 14). Google itself was less than a year old. Its corporate headquart ers were in a garage.Fast forward to 2018. I used Google to obtain 10...
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 18, 2018 Category: Palliative Care Tags: social work social worker The profession washington Source Type: blogs

Book Review: “The Four Things That Matter Most” by Ira Byock
by Ben Skoch (@skochb)As someone new to the field of hospice and palliative medicine, I recognize that “The Four Things That Matter Most” by Ira Byock has been around for some time. As I sit down to write this review, I ’m reminded of ajoke from comedian Jim Gaffigan when he referenced people who want to talk about movies many years after they are released. That being said, the book was new to me as I picked through the 10th Anniversary Edition, and it ’s easy to see why this book could easily have many more anniversary editions in the coming years. I was indirectly nudged to read this work while on my inpatient ho...
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 15, 2018 Category: Palliative Care Tags: book review Byock skoch Source Type: blogs

Pallimed Calendar of Conferences and Events
Most of the items on this calendar are focused on significant national or international conferences, but also include some historical events related to our field. Occassionally regional or local conferences may be included. You can sync this calendar with many dfferent software platforms and apps or just pick certain events to add to your calendar. This list of palliative care and hospice related events and conferences is maintained by Ishwaria Subbiah (@IshwariaMD), Allison Jordan (@doctorjordan), and Christian Sinclar (@ctsinclair).If you would like to help, have feedback or see an error, please contact us via Twitter. (...
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 12, 2018 Category: Palliative Care Tags: calendar jordan sinclair subbiah Source Type: blogs

Grief and the Healing Property of Time
This article will not begin to address the complexities presented in suicidal, homicidal, child or antepartum, perin atal, or postpartum bereavement.)For most adults who experience the death of a loved one, they will move through normal grief reactions without any pathology.[11] What I try to reframe are the expectations we have regarding what ’s “appropriate coping”. Sometimes I get called to a family because the patient or family is crying too much; other times it’s because they aren’t crying at all. What I want everyone to know is either response is acceptable. Grief can cause you to withdraw from people and a...
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 10, 2018 Category: Palliative Care Tags: bereavement grief latimer Source Type: blogs

Little Legacies: The Solace and Connectedness of Ellie ’s Boxes
by Kristina Newport (@kbnewport)In 2016, the palliative care community lost a dedicated advocate and compassionate caregiver when Eloise “Ellie” Coyne died. She was well-known to the Virginia Commonwealth University (VCU) Community where she held the position of Volunteer Coordinator but her colleagues knew the all different roles she played for patients and staff on the 11 bed unit: mother, advocate, healer, listener, comforter and mother. Of all the many things Ellie provided to her patients and colleagues, perhaps the most important was here complete acceptance of all people, with an uncanny ability to meet people e...
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 3, 2018 Category: Palliative Care Tags: grief hospital interprofessional newport palliative care The profession volunteer Source Type: blogs