How Proposed Changes to Medicare Documentation Regs Can Impact Palliative Care
by Amy Davis (@MaximizeQOL)(CMS open to comments until Sep 10, 2018. See end of post for details. - Ed.)Centers for Medicare and Medicaid Services (CMS) hasproposed sweeping reforms to documentation requirements, clinician reimbursement, and the Quality Payment Program (QPP), to begin in 2019. (1) If approved in their current form, the changes are likely to have dramatic net negative effects on outpatient palliative care reimbursement. A detailed review and analysis of all 1,473 pages of the Proposed Rule, plus its addenda, would not be practical here. The reader is referred to thecomplete text (1) andothers ’ asses...
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 2, 2018 Category: Palliative Care Tags: billing CMS davis The profession Source Type: blogs

End-of-Life Learning from the Philosophy of Ninjas
The objectives of the ninjas are: first, to use ninjutsu to infiltrate the enemy’s camp and observe the situation.” (Hatsumi, 1988 p. 111).How it applies to hospice: Everyone involved in a hospice situation, including the patient, their loved ones, and the staff, are observing everyone else.* The patient often can be stuck in a role of observation whether they chose to or not because they may be too tired to interact, or the family will talk in front of them to staff.* The family is often on high alert, watching the patient for symptoms or watching the staff and timing our responses.* The staff members are observing th...
Source: Pallimed: A Hospice and Palliative Medicine Blog - July 30, 2018 Category: Palliative Care Tags: hospice miles ninjutsu perseverance social work social worker spiritual Source Type: blogs

Ninjutsu for the Hospice Patient
The objectives of the ninjas are: first, to use ninjutsu to infiltrate the enemy’s camp and observe the situation.” (Hatsumi, 1988 p. 111).How it applies to hospice: Everyone involved in a hospice situation, including the patient, their loved ones, and the staff, are observing everyone else.* The patient often can be stuck in a role of observation whether they chose to or not because they may be too tired to interact, or the family will talk in front of them to staff.* The family is often on high alert, watching the patient for symptoms or watching the staff and timing our responses.* The staff members are observing th...
Source: Pallimed: A Hospice and Palliative Medicine Blog - July 30, 2018 Category: Palliative Care Tags: hospice miles ninjutsu perseverance social work social worker spiritual Source Type: blogs

Book Review: “Everything Happens For A Reason and Other Lies I’ve Loved” by Kate Bowler
by Andrew Garcia (@ndyG83)“We can focus on your comfort always means we’re giving up.” I can’t count how many times I’ve heard this sentiment from both patients and other healthcare providers, and to read it both frustrated and encouraged me at the same time. It’s frustrating because to know that what I do, as a palliative care physician, to help patients and their families during some of their darkest, scariest, heartbreaking and most painful moments, is seen as ' giving up ' when it couldn ’t be any more different. Yet, I also find it encouraging because it reminds me that there is much work left to be done...
Source: Pallimed: A Hospice and Palliative Medicine Blog - July 7, 2018 Category: Palliative Care Tags: book book review cancer garcia patient experience Source Type: blogs

True Confessions On Why I Prescribe Things Without'Evidence '
by Drew RosielleWe have a ' required reading ' list for our fellowship, which includes a bunch of what I think are landmark or otherwise really important studies. One of them is thisvery well done RCT of continuous ketamine infusions for patients with cancer pain, which showed it to be ineffective (and toxic).We also recently have seen another high-quality study published with negative results for ketamine. This was a Scottish, multi-center, randomized, placebo-controlled, intention-to-treat, and double-blinded study oforal ketamine for neuropathic pain in cancer patients. The study involved 214 patients, 75% of whom were ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - July 6, 2018 Category: Palliative Care Tags: fatigue ketamine methylphenidate neuropathic pain research research issues rosielle The profession Source Type: blogs

True Confessions On Why I Prescribe Things Without'Evidence '
by Drew RosielleWe have a ' required reading ' list for our fellowship, which includes a bunch of what I think are landmark or otherwise really important studies. One of them is thisvery well done RCT of continuous ketamine infusions for patients with cancer pain, which showed it to be ineffective (and toxic).We also recently have seen another high-quality study published with negative results for ketamine. This was a Scottish, multi-center, randomized, placebo-controlled, intention-to-treat, and double-blinded study oforal ketamine for neuropathic pain in cancer patients. The study involved 214 patients, 75% of whom were ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - July 6, 2018 Category: Palliative Care Tags: fatigue ketamine methylphenidate neuropathic pain research research issues rosielle The profession Source Type: blogs

Let's Stop Claiming That Palliative Care Improves Survival
by Drew RosielleHospice and palliative care community, I ' m calling for a moratorium on all blanket, unqualified claims that hospice and palliative care improve survival.Let ' s just stop doing this.There has never been any actual evidence that palliative care (PC) interventions improve survival in patients, but since thelandmark Temel NEJM 2010 RCT of early outpatient palliative care for lung cancer patients showed a clinically and statistically significant improvement in longevity in the PC arm, I have heard and all read all sorts of statements by palliative people and all sorts of others (hospital executives, poli...
Source: Pallimed: A Hospice and Palliative Medicine Blog - June 30, 2018 Category: Palliative Care Tags: lung cancer palliative palliative care quality of life rosielle temel The profession Source Type: blogs

Let's Stop Claiming That Palliative Care Improves Survival
by Drew RosielleHospice and palliative care community, I ' m calling for a moratorium on all blanket, unqualified claims that hospice and palliative care improve survival.Let ' s just stop doing this.There has never been any actual evidence that palliative care (PC) interventions improve survival in patients, but since thelandmark Temel NEJM 2010 RCT of early outpatient palliative care for lung cancer patients showed a clinically and statistically significant improvement in longevity in the PC arm, I have heard and all read all sorts of statements by palliative people and all sorts of others (hospital executives, poli...
Source: Pallimed: A Hospice and Palliative Medicine Blog - June 30, 2018 Category: Palliative Care Tags: lung cancer palliative palliative care quality of life rosielle temel The profession Source Type: blogs

Don't ask a dying man if he wants bacon or sausage
by Lizzy MilesIt has been four years since I first wrote the article“We Don’t Know Death: 7 Assumptions We Make about the Dying” for Pallimed. You would think that with four more years of experience I would feel more confident in my knowledge about my job and my patients. I don ’t.In fact, I ’m still uncovering assumptions that I make when working with patients who are dying.Recently, I discoveredAssumption #8: Dying patients want to be in control.I had so many reasons and examples to believe this, from the very beginning of my hospice work. I came to this conclusion after just a short timevolunteering. One of th...
Source: Pallimed: A Hospice and Palliative Medicine Blog - June 14, 2018 Category: Palliative Care Tags: communication control hospice lizzy lizzy miles psychosocial social work social worker Source Type: blogs

Don't ask a dying man if he wants bacon or sausage
by Lizzy MilesIt has been four years since I first wrote the article“We Don’t Know Death: 7 Assumptions We Make about the Dying” for Pallimed. You would think that with four more years of experience I would feel more confident in my knowledge about my job and my patients. I don ’t.In fact, I ’m still uncovering assumptions that I make when working with patients who are dying.Recently, I discoveredAssumption #8: Dying patients want to be in control.I had so many reasons and examples to believe this, from the very beginning of my hospice work. I came to this conclusion after just a short timevolunteering. One of th...
Source: Pallimed: A Hospice and Palliative Medicine Blog - June 14, 2018 Category: Palliative Care Tags: communication control hospice lizzy lizzy miles psychosocial social work social worker Source Type: blogs

Pallimed Birthday - Lucky 13
by Christian SinclairAnniversaries are a fun time to celebrate, but the fun ones end in numbers in 0 or 5. For other anniversaries, it is a good time to take stock, reflect on the past and look towards the future.Today is our 13th anniversary of Pallimed, which Dr. Drew Rosielle started in 2005 when blogs wereTHE thing to do in social media. We also spent many of those early years helping people understand the power of communication through social media with projects like#hpm chat on Twitter, encouraging tweeting from conferences and the advocacy power of ourPallimed Facebook page. With that focus, we have drifted awa...
Source: Pallimed: A Hospice and Palliative Medicine Blog - June 8, 2018 Category: Palliative Care Tags: meta sinclair Source Type: blogs