The Life Matters Media Newswire aims to serve as a comprehensive portal of all news related to end of life decision making and care. We aggregate stories from other media outlets in one place- here, where you can access them easily. We also strive to produce original content covering stories we feel are receiving scant attention.
A new payment system would change the way hospice providers are reimbursed for care provided to dying patients.
The payment system, proposed in May by the Centers for Medicare and Medicaid Services (CMS), would establish a two-tiered payment model for patients receiving the routine home level of hospice care, based on length of stay. It is scheduled to go into effect by early fall.
It would be the first major change to hospice payments in nearly 30 years, establishing a higher payment rate for a patient’s first 60 days in hospice and a lower rate thereafter.
Bipartisan legislation to test the new model before national implementation, H.B. 3037, was introduced Tuesday by Reps. Tom Reed, R-N.Y., and Mike Thompson, D-Calif. It calls for a one-year pilot program of only one payment jurisdiction.
The National Hospice and Palliative Care Organization enthusiastically supports the bill, because members are concerned that payment reform will be implemented too quickly and without proper testing. Most hospice programs rely primarily on Medicare reimbursement.
“This legislation seeks to have CMS test the new payment methodology that they intend to enact October 1. The hospice community is very concerned about CMS, as well as their contractors and software vendors, who also have to make changes to facilitate a smooth transition to the new methodology,” said Jonathan Keyserling, NHPCO senior vice president for health policy and legal counsel. “We’re very concerned that CMS does not have the infrastructure or procedures in place to make a smooth transition. We would like to see the new system put in place as soon as it is ready.”
In addition to payment reform testing, H.B. 3037 would direct CMS to conduct a medical review of providers with troubling survey results, such as a high percentage of live discharges between 120 and 180 day stays or patients receiving no skilled visits in the last seven days of life.
The bill also calls on CMS to require hospitals to provide patients being discharged who are likely to need hospice care with a list of Medicare-certified hospices serving their area.
Reps. Reed and Thompson were not immediately available for comment.
Hospice care aims to provide comfort care and pain management rather than aggressive treatments for terminally ill patients with six months or less to live. Hospice is most often used when curative treatments are no longer effective.
On Tuesday, hundreds of hospice advocates gathered on Capitol Hill to voice their concerns as part of the Hospice Action Network’s Advocacy Intensive.
Medicare plans to reimburse physicians for counseling patients about their end of life care options.
The unexpected change comes nearly six years after similar proposals were dropped from President Obama’s health reform law and inaccurately compared to “death panels” by some conservative politicians, most notably former Alaska Gov. Sarah Palin.
The policy change, effective January 1, is part of a massive regulation released Wednesday. The change follows recommendations from the American Medical Association to make advance care planning services a separately payable service under Medicare.
“As a practicing physician, and a son, and someone who has dealt with this in his own family, I would say these are discussions … that are critical to high-quality care,” Patrick Conway, Medicare’s chief medical officer, told the Associated Press. “I would want any American who wanted to have this conversation with their clinician to have the opportunity to do so.”
The Centers for Medicare & Medicaid Services could not be reached for further comment.
Some physicians already have end of life conversations with their adult patients without billing for it, and some private insurers offer reimbursement.
But advocates hope Medicare coverage for some 55 million older Americans will make such talks more common and encourage patients to complete advance health care directives, such as a living will or power of attorney document.
The National Hospice and Palliative Care Organization praised the policy change.
“NHPCO has long championed the need for Americans to talk about and document their healthcare preferences with their loved ones and healthcare professionals,” said NHPCO President J. Donald Schumacher in a statement sent to Life Matters Media. “More and more Americans are facing advanced illness and are aging with multiple chronic health conditions, so it’s now more important than ever to have these vital conversations.”
Concerned parties have 60 days to comment on the new regulation before it is finalized.
The ruling comes almost a year after a widely circulated report from the Institute of Medicine found that far too many Americans avoid serious discussion about their care wishes and as a result receive unwanted, unnecessary and often painful treatments in their last moments of life.
The report cited the present as the best time to encourage advance care planning, partly because of the aging population and growing number of Americans living longer with chronic diseases.
“Most people nearing the end of life are not physically, mentally, or cognitively able to make their own decisions about care…Therefore, advance care planning is essential to ensure that patients receive care reflecting their values, goals, and preferences,” according to the 2014 report. “Of people who indicate end of life care preferences, most choose care focused on alleviating pain and suffering. However, because the default mode of hospital treatment is acute care, advance planning and medical orders are needed to ensure that these preferences are honored.”
Medicare plans to pay doctors to counsel patients about their end of life care options.
The change comes six years after similar proposals were taken out of the President Obama’s health reform law and inaccurately compared to “death panels” by some conservative politicians.
The policy change, effective Jan. 1, is part of a massive regulation issued Wednesday, The Associated Press reports.
“As a practicing physician, and a son, and someone who has dealt with this in his own family, I would say these are discussions … that are critical to high-quality care,” Patrick Conway, Medicare’s chief medical officer, told the AP. “I would want any American who wanted to have this conversation with their clinician to have the opportunity to do so.”
Illinois could soon become the fifth state to allow video cameras and audio recording devices in nursing homes if Gov. Bruce Rauner signs legislation easily approved by the General Assembly and backed by the state’s attorney general.
The legislation, HB 2462, would require resident and roommate consent and make nursing home residents or their families responsible for the purchase and maintenance of video devices. A physician would need to determine if a resident is capable of consent.
“Placing a loved one in a nursing facility is a difficult decision that many families will face,” Attorney General Lisa Madigan said in a statement to Life Matters Media. “This measure provides an extra layer of security for nursing home residents, while giving their families peace of mind knowing that their loved ones are receiving safe, quality care.”
The initiative stems from complaints that Madigan has received from nursing home residents and families concerned about care and security.
No one from Gov. Rauner’s office responded to requests for comment.
The legislation is concerning to many, and some privacy and nursing advocates caution that it would unfairly burden caregivers and shame incapacitated and dying patients.
“It’s one thing to have cameras in your own home, if you got a babysitter for your child or some caregiver, but a nursing home is a whole different ball game,” said Dr. June McKoy, associate professor of geriatrics and internal medicine at Northwestern University’s Feinberg School of Medicine. “A lot of nursing homes don’t have private rooms, and proponents claim they can have a ‘granny cam’ targeted at those who give consent. But if I’m in a room with someone else, I wouldn’t want a camera. Period.”
McCoy has never heard of a patient asking for a camera, and she said those suffering from dementia or immobility could be recorded during private moments like baths or linen changes.
“You have caregivers going in and cleaning them, bathing them, doing intimate things to them, and that will all play out on camera, which will affect how caregivers and nursing assistants provide care,” McCoy added. “They do a lot of extra work for patients that should not be on camera.”
Mike Duffy, administrator of Good Samaritan Home, said that allowing recording devices is understandable, but he is concerned about multi-occupant rooms and patient freedom. He does not support the use of cameras in his nursing home.
“Can a resident give proper consent for themselves to be videotaped? It would probably often be a family member that is putting a camera in,” Duffy told the Quincy Harold-Whig.
A roommate may consent to authorized electronic monitoring with any condition of his or her choosing, including that a device be turned off or that recording be blocked at any time.
Illinois has more than 1,100 nursing home facilities with nearly 76,000 residents. The U.S. Census Bureau estimates that by 2030, almost one quarter of Illinois’ population will be 60 and older. In 2013, the Illinois Department of Public Health found 106 valid allegations of abuse, neglect or misappropriation of property against residents by facility staff.
If the bill is enacted, Illinois would become the fifth state (joining New Mexico, Oklahoma, Texas and Washington) to explicitly allow the installation of electronic monitoring devices. The recordings could be used in court for allegations of abuse.
The law would also require the Department of Public Health to distribute by lottery up to $50,000 yearly to residents unable to pay for their own devices.
Support for physician-assisted suicide is proliferating in state legislatures across the nation as proponents contend the practice enhances patient freedom at the end of life and guarantees terminally ill adults a way out of pain and suffering.
Physician-assisted suicide is legal in only a handful of states including Oregon (the first state to legalize the practice in 1997), Washington (passed by ballot measure), Vermont (passed by state Legislature), New Mexico and Montana (allowed by the courts).
However, support for so-called “Death with Dignity” legislation has grown in recent years as advocates, including Compassion & Choices and the Death with Dignity National Center, work to turn the issue into a political and social movement. It seems to be working in California, the nation’s most populous state.
Senate Bill 128 (The End Of Life Option Act) by State Senators Bill Monning and Lois Wolk recently passed through the Senate 23 to 15. The legislation is now in the Assembly and will be voted on in early July.
“I’m cautiously optimistic that it will pass, but you never ever know for certain until the day of the vote,” George Eighmey, vice president of the Death With Dignity National Center, told Life Matters Media. “There are many people who are facing death who wish to have one more option in considering how their life is going to end, in addition to palliative care, hospice care, taking medicine or not taking medicine.”
On the East Coast, Maine’s “Death with Dignity” bill, LD 1270, was narrowly defeated by a single vote in the Senate in June. In 2012, voters in Massachusetts, one of nation’s most Catholic states, narrowly voted down a similar referendum.
Shortly after the Vermont legislation became law, Peg Sandeen, executive director of the Death with Dignity National Center in Oregon, told LMM she believes Midwestern states, including Illinois, may be 10 years away from passing some form of “Death with Dignity” legislation.
Mark Sheldon, distinguished senior lecturer in the Medical Humanities and Bioethics Program at Northwestern University, said he is evolving on the issue as he grows older.
“For a very long time I was very opposed to assisted death, but in the last decade or so I became a supporter of it under certain circumstances,” Sheldon said. He would support aid-in-dying for patients seeking a sense of control over their death and facing extreme pain.
“I’m aware of the arguments against it, and palliative (comfort) care is important, but there are instances when adequate pain control is not available,” he added. “Sometimes adequate pain control is very heavy sedation, and that’s something that makes me uncomfortable.”
Sheldon, who does not wish to be a financial burden to his family if he ever becomes seriously ill, told LMM that assisted-death is a viable option for him. He would rather save resources for his children.
Still, the public remains closely divided on the issue, with 47 percent in favor of laws that would allow doctor-assisted suicide for terminally ill patients and 49 percent opposed, according to PEW Research.
Despite calls for legalization from a growing number of proponents, the American Medical Association remains firmly opposed to such policy. The Chicago-based AMA is the nation’s largest organization of physicians, representing nearly 200,000 doctors, medical students and residents.
“It is understandable, though tragic, that some patients in extreme duress – such as those suffering from a terminal, painful, debilitating illness – may come to decide that death is preferable to life,” according to a statement sent to LMM. “However, allowing physicians to participate in assisted suicide would cause more harm than good.”
Many physicians, bioethicists and religious leaders caution that physician-assisted suicide is incompatible with physicians’ primary role as healer and would foster resentment towards sick people hoping to live as long as possible, no matter the costs.
Mark Kuczewski, director of the Neiswanger Bioethics Institute at Loyola University Chicago, is concerned that society and medical providers have become too focused on making dying patients “productive” and not content with just “being.” That mindset, Kuczewski added, leads some to view dying patients as unnecessary and even weak.
“Once we go down that road, it’s very hard for us to retain the alternate option: to help people live every moment of their remaining life with quality and dignity. There’s a tendency, once you institutionalize it, for the right-to-die to become the duty to die,” Kuczewski said. “Once you have a society that facilitates this, once you have that, it’s so easy the way that mixes with our culture, for it to be hard for anybody to be a healer in those situations or have an alternate point-of-view.”
Others point to advances in hospice and palliative medicine that can help to alleviate pain. But proponents of physician-assisted suicide, including Eighmey, say just knowing the option to end life is available can serve as a source of comfort.
The Brittany Maynard effect
Many right-to-die advocates credit the recent high-profile death of 29-year-old Brittany Maynard for raising awareness about the issue amongst so-called Millenials (adults 18 to 32).
In 2014, Maynard was diagnosed with an aggressive glioblastoma brain tumor and was later given six months to live. Maynard and her husband, Dan Diaz, moved from California to Oregon because that state did not allow terminally ill adults to end their lives with doctor-prescribed barbiturates.
Working with Compassion & Choices, Maynard used her story to raise awareness about the practice and inspire other terminally ill Americans to end their lives on similar terms. She ended her life later that year, sparking headlines across the world.
“I don’t wake up every day and look at it, I know it’s in a safe spot,” Maynard said in a Compassion & Choices-produced video about her life-ending drugs. That video has been viewed more than ten million times via YouTube. “I will pass peacefully with some music I like in the background.”
Like Eighmey, Compassion & Choices President Barbara Coombs Lee said Maynard “changed everything,” partly because she introduced Americans to the human side of the issue.
“She has single-handedly transformed our whole movement from from one organization working actively in the field to a broad movement where all kinds of people are introducing bills and filing lawsuits and becoming active,” she said last year in Chicago. “We will see bills advancing in many, many states. Her brazen visibility helped to increase momentum.”
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- Reuters Health: LMM Reports
- Voices in Bioethics: LMM Commentary
- Activist Finds Inspiration In Death
- Writing Coach Hopes Boomers Share Their Life Stories
- Fulfilling ‘Three Wishes’ Helps ICU Staff Honor Dying Patients
- After 30 Years, Changes To Medicare Reimbursement Of Hospice Care
- Six Years After ‘Death Panels’ Debate, Medicare To Pay For End Of Life Talks
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Daniel Gaitan serves as a content producer...More