100 Most Influential People in Healthcare 2015

Modern Healthcare released their annual 100 Most Influential People in Healthcare List this week, and unfortunately none of us here at HAN made the cut…

But, importantly for the end-of-life care community, Surgeon and Author Dr. Atul Gawande is back on the list this year, coming in at number 10. Do you recognize anyone else on this list? What can we do to raise the profile of people active in our movement? Are you surprised that anyone is not included? Let us know in the comments!

Dr. Atul Gawande
Dr. Atul Gawande

Rural Hospice Issues and #HPM Chat

The main topic last night at the weekly #HPM chat was issues faced by rural hospice providers. As proud Jersey Girl and current resident of (just outside) the Beltway, I will admit that I am not incredibly familiar with rural living at all, much less the specific needs of rural hospice providers. I assumed driving and finding quality staff would be an issue, but some of the statements really surprised me:



I will admit, Meredith’s response really surprised me. And hers was not the only one along these lines. I realized that, while my job does require me to be in DC and focus mainly on DC-centric policy issues, I want to gain a better understanding of what hospice looks like in varying environments. I dug through our archives, and found this great video that helped me understand a little better what serving rural hospice patients is like:

I found both #HPM chat and Kim’s video to be eye-opening and incredibly interesting. NHPCO has a Rural Taskforce, and our newest Newsline publication focuses on rural hospice issues. I will be doing some more research of my own as well as utilizing these two resources, and I also welcome any stories you rural warriors would like to share!

Quick Take: Media Coverage of MCCM

Last month I shared a breakdown of the Medicare Care Choices Model. In brief, the Medicare Care Choice Model (MCCM) is designed to evaluate whether eligible Medicare and dually eligible beneficiaries would elect to receive supportive care services typically provided by hospice if they could also continue to receive curative services. CMS originally anticipated selecting at least 30 Medicare-certified hospices to participate in the model and enrolling up to 30,000 beneficiaries throughout a 3-year period. Due to robust interest from the hospice community, CMS has invited over 140 Medicare-certified hospices to participate in the model and expanded the duration of the model to 5 years.

Exciting, right?! What’s even more exciting is that national news outlets are picking up on this initiative! The Washington Post published an article on MCCM just this week. Those of us in the hospice and palliatve care community aren’t the only ones sharing the news of MCCM and its potential. Such national media attention raises the profile of the program across the country, and has the potential to reach thousands (or even millions?) who don’t generally follow hospice issues so closely. They may not know much about hospice. But articles like this helps educate the public from a trusted third-party perspective. It might be shared with a relative that may meet the MCCM criteria in Massachusetts. Or an eligible patient in Wisconsin may raise it with his doctor. Or discussed in a med. school study group in Ohio. As more information is shared about MCCM, the greater the possibility for MCCM to show its value and thrive.

Map of MCCM Awardees, via CMS. Click the image above for an interactive map on CMS.gov.


HAN is here to help. No, seriously.

It may surprise some of you out there on the internet, but I have been known to have a bit of a cheeky side. I made a bit of a snarky tweet the other day:

Now, I’m not going to lie, I do see lots of advertisements and tweets in this vein. Someone will send me an email saying ‘FREE WEBINAR’, and what follows is a thinly veiled marketing pitch for a company’s services. Thanks to the webinar registration process, they now also have your email address and name… ugh. (Fun tip, if/when you sign up for such a webinar, instead of giving them your first name, give them something like ‘Commander Awesome’. This way, when they inevitably email you afterwards, at least their email will start with ‘Dear Commander Awesome,…’)

But I digress (can you tell it’s August?).

The thing is, I actually presented a webinar yesterday, and it wasn’t at all in this vein! You see, HAN isn’t trying to sell the hospice community anything. We are just trying to get as much good information out there about Hospice Advocacy as we can. To that end, I gave a webinar to a multi-site hospice program yesterday that updated them on the state of hospice public policy, and identified some concrete things they could do to engage their Members of Congress in the process of affecting change on those policy issues. We even identified the key Members of Congress served by that particular hospice program to give them the tools they needed to make the biggest impact for the hospice community.

You may not know this, but we are happy to do customized webinars for any hospice that requests them. If you want us to present at your all-staff meetings about the hospice policy/advocacy landscape, we’re there. Same goes for site directors, leadership teams, or even your Board of Directors. We even have the software to run it- at no cost to you. You see, an informed hospice community is one that’s willing to take action when it’s needed most, and so that’s what we strive to achieve. If you want more information, you can email me at akudner [at] nhpco [dot] org. I’ll be happy to talk to you about how we can help.

Plus, we won’t try to sell you a timeshare in the Florida swamps. We promise.

A Hospitalist’s Take on EOL Discussions

When a patient is in a hospital receiving treatment for a life-limiting illness, whose responsibility is it to discuss end of life care options with the patient? The radiologist? Oncologist? Hospitalist?

In a recent article in The Atlantic, hospitalist Ricardo Nuila, MD, reflects on just this question. As the coordinator of his patient’s care, Nuila discusses that he never quite “connected the dots” in terms of what Pedro’s treatment meant regarding life expectancy.

By not telling him clearly what the progression of his cancer meant, had I inched him toward a hospitalized death, one that involved shocking his heart if it stopped and pureed food and waking him up every four hours for vital signs?

But Nuila has hope that the new advance care planning codes, allowing medical professionals to bill for time for advance care planning conversations with patients. He argues that the new reimbursement codes will not simply incentivize medical professionals to have care planning discussions with their patients, but assign responsibility over these conversations.

Photo: Philippe Wojazer / Reuters

Now I don’t want this to be a book report; I encourage you to read the full article online. But let’s go back to the beginning of this article. Nuila discusses a team of healthcare providers was treating Pedro’s condition. What if care planning discussions themselves followed a team-based approach as well? One that developed a care plan documenting the patient’s goals, values, and preferences? That’s precisely what The Care Planning Act (S. 1549) sets out to do. If a team of specialists is expected to care for an individual’s illness, why not have a team of professionals with different perspectives help a patient sort through treatment options, risks and rewards, and develop their personal care plan? The advance care planning codes are a great start to reimbursing medical professionals for these conversations, but let’s not stop there. Let’s see a collaborative approach among medical professionals not just treating an illness, but one that openly discusses the care options available to the patient as well.