Posts Tagged ‘end of life care’

Infographic: Medicare and End-of-Life Care

November 23rd, 2016 by Melanie Matthews

Although Medicare spent significantly more on care for people at the end of life who died in 2014 ($34,529 per person) than for other beneficiaries that year ($9,121 per person), the share of total Medicare spending for people at the end of life decreased from 18.6% to 13.5% between 2000 and 2014, according to a new Visualizing Health Policy infographic by the Kaiser Family Foundation.

The infographic also examines Medicare spending for end of life care by age, Medicare spending on hospice and the impact of Medicare reimbursement to discuss end of life care, which began in January 2016.

Medicare and End-of-Life Care

Care Coordination in an ACO: Population Health Management from Wellness to End-of-LifeWhen acknowledging its position as a top-ranking Medicare Shared Savings Program (MSSP), Memorial Hermann is quick to credit its own physicians—who in 2007 lobbied for a clinically integrated network that formed the foundation of the current Memorial Hermann accountable care organization (ACO). Now, eight years later, collaboration and integration continue to be the engines driving the ACO’s cost savings, reduced utilization and healthy patient engagement rates associated with Memorial Hermann ACO’s highest-risk population.

Care Coordination in an ACO: Population Health Management from Wellness to End-of-Life details Memorial Hermann’s carefully executed journey to quality and the culmination of the ACO’s community-based care management program.

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End-of-Life Care: Infographic

June 3rd, 2015 by Melanie Matthews

Only 27% of Americans report having talked with their families about end-of-life care, according to a new infographic by Vitas Healthcare.

The infographic examines the need for a living will and a medical power of attorney and the communication needs about these documents.

Case Management for Advanced Illness: Best Practices in End-of-Life CarePoor prognoses, the loss of functional capabilities, and the need for advanced care planning are just some of the emotionally charged challenges of caring for individuals with advanced illness.

Case Management for Advanced Illness: Best Practices in End-of-Life Care examines Aetna’s Compassionate Care program, a case management approach for this population. The payor’s initiative breaks down barriers commonly encountered in this highly sensitive stage of the health continuum while positively impacting both healthcare utilization and spend.

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Infographic: Decision-Making in Cancer Care

March 6th, 2015 by Melanie Matthews

Cancer patients should be involved with decisions about their care and should understand the goals of treatment and prognosis of their disease, according to a new infographic by the National Coalition for Cancer Survivorship.

The infographic examines the current state of prognosis and end-of-life care discussions.

2014 Healthcare Benchmarks: Palliative CareWhile the word ‘palliative’ literally means to cloak or conceal, healthcare is taking the wraps off this critical service — in spite of provider resistance. Recent data increasingly supports the thesis that a well-timed palliative care consult can enhance the patient experience and foster appropriate use of healthcare resources.

2014 Healthcare Benchmarks: Palliative Care documents emerging trends in palliative care at 223 healthcare organizations, from the timing for initial palliative care consults to individuals on the palliative care team to the impact this specialized care is having on healthcare utilization and the patient experience — two critical markers of healthcare performance.

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Early Palliative Care Improves Patient Care, Reduces Hospitalizations

January 15th, 2014 by Cheryl Miller

The word palliative literally means to cloak or conceal, and is used to describe care designed to alleviate the extreme pain and suffering of those with chronic or terminal illnesses.

It’s an ironic name for a subject many medical professionals would prefer be concealed. There’s a shortfall of as many as 18,000 board certified physicians focused on palliative care and hospice care in the United States. There are 5,150 hospice programs and 1,635 hospital palliative care teams in the United States, which means there’s only one specialist for every 20,000 older adults living with a severe chronic illness, according to the American Academy of Hospice and Palliative Medicine.

Certification roadblocks and lower salaries account for part of this shortage; but, it could also be chalked up to discomfort with the subject. According to a study from Massachusetts General Hospital, which surveyed over 4,000 physicians caring for cancer patients, researchers found that while the vast majority of them said they would personally enroll in a hospice program if they received a terminal cancer diagnosis, less than one-third said they would discuss hospice options with their cancer patients early in their diagnosis.

But new research, including the results to our current 10 question survey on palliative care, is showing that palliative care programs are increasing, and can improve the patient experience and help avoid costly hospitalizations. New York University College of Nursing researchers and colleagues reporting in the Journal of Palliative Medicine found that initiating a palliative care consult in the emergency department (ED) reduced hospital length-of-stay (LOS) by 3.6 days when compared to patients who received the palliative care consult after admission. The ED is a setting for triage, treatment, and determining the sick patient’s subsequent course of care, which in this case includes a dedicated palliative care unit.

“By providing early palliative care, patient needs are met earlier on, either preventing admission or reducing length of stay and treatment intensity for patients, which reduces costs to Medicare and the government,” says New York University College of Nursing researcher and Assistant Professor Abraham A. Brody, RN, PhD, GNP-BC. “Patients receiving palliative care are less likely to be readmitted as well. Early palliative care can better help patients to have their wishes met, and allow them to return to and stay at home.”

Helping people decide how they want to spend the rest of their lives, and granting their wishes might be the most important palliative care treatment of all. NPR reports on Dr. Tim Ihrig of Trinity Regional Medical Center in Fort Dodge, Iowa, who makes house calls to his patients nearing their end of life. “What are the three most important things to you,” he asks his patient, an 86 year-old wife, mother, grandmother, and great grandmother with congestive heart failure. She answers: “My girls, playing cards once a week, and counting money for the church once a month,” and he helps her to achieve that. Patients in palliative care at Trinity Regional Medical Center cost the healthcare system 70 percent less than other patients with similar diagnoses, hospital officials say.

And palliative care isn’t going away, in fact, it’s spurred a new HBO comedy series, Getting On. Taking place in an extended care facility, the short-staffed ward tries their best to tend to their patients — some of whom have Alzheimer’s disease, but most of whom are simply old &#151 while hoping they don’t lose their Medicare reimbursement. The series makes jokes about everything from displaced fecal matter to sex, attempting to make fun out of a subject that’s been cloaked, or concealed, for a long time. Whether the series is renewed remains to be seen, but at the very least it’s provided a look at the kindness a group of workers can give their patients nearing the end of their life.

Healthcare Business Week in Review: Yoga for Caregivers, Diabetes Management, Healthcare Coverage

August 2nd, 2013 by Cheryl Miller

Offering yoga and meditation classes to caregivers of seriously ill patients just prior to starting clinical meetings on palliative care issues is one detail that sets Mount Sinai Hospital’s palliative care program apart from others. Together with Denver Hospice and Optio Health Services in Colorado, and UnityPoint Health Palliative Care Program in Iowa and Illinois, these three palliative care programs received the 2013 Circle of Life Award®, along with five others that were awarded Citations of Honor from the American Hospital Association (AHA).

Other programs involve a community-wide program to embrace the growing Hispanic community, and regular outpatient and home visits to ensure proper care transitions, and help avoid unnecessary emergency room visits and readmission to the hospital. All of the programs set out to reexamine the roles palliative care plays in healthcare by creating and championing end-of-life care for patients and caregivers throughout the healthcare system.

Providers need to reexamine certain diabetes monitoring practices that solely target acute individuals, and instead take a population health management approach to improving diabetes care, according to a Phytel study published in the American Journal of Managed Care.

Researchers found that despite national attention, uncontrolled diabetes was growing, and those patients at real risk were those that waited to seek care until their condition was exacerbated to an acute phase. A broader population-based approach was required to catch at-risk patients. Researchers recommend that provider organizations take two important steps to improve their ability to help their patients better manage their diabetes, including reaching out to their entire population between office visits so patients waiting too long to get retested are motivated to have the testing done earlier.

Economists need to reexamine their data linking the employment rate with healthcare coverage. Despite economic reports showing that the recession is over, the percentage of workers with health benefits still remains low, according to a new report by the nonpartisan Employee Benefit Research Institute (EBRI).

Links between the employment rate and health insurance coverage have been documented over the years. Since most workers in the United States get their health coverage through their jobs, a rise or drop in the unemployment rate usually means a corresponding rise or drop in the uninsured rate as well, the report states.

But these facts aren’t holding up against trends that show that nearly half of the population does not have coverage.

We’d like you to examine and respond to our current e-survey on the population health management of dual eligibles. These nine million Americans eligible for both Medicare and Medicaid present unique challenges. Public and private payors are now tailoring care coordination strategies for Medicare-Medicaid beneficiaries that are both geared to their medical, social and functional needs and cost-efficient. Describe your organization’s approach to care coordination of dual eligibles by August 6, 2013 and you will receive a free summary of survey results once it is compiled.

Infographic: End-of-Life Care in California

May 17th, 2013 by Patricia Donovan

Californians, like many Americans, frequently do not get the kind of care that they want at the end of their lives. This infographic from the California Healthcare Foundation documents research on end-of-life care for Medicare beneficiaries, and analyzes it in light of what is known about Californians’ preferences for care as they approach death.

The research found sharp variation that cannot be explained by differences among patients in age, sex, or race.

End-of-Life Care in California

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You may also be interested in this related resource: Case Management for Advanced Illness: Best Practices in End-of-Life Care.

Meet Healthcare Case Manager Sonia Morrison: Respect and Kindness Key to End of Life Care

June 15th, 2012 by Cheryl Miller

This month we provide an inside look at a healthcare case manager, the choices she made on the road to success, and the challenges ahead.

Sonia Morrison, RN, CM, BSN, RN case manager at Salinas Valley Memorial Healthcare System (SVMHCS), Nurse Assessment Consultant and Educator for veterans at Visiting Angels of Santa Cruz

HIN:Tell us a little about yourself.

I am certified as a nurse case manager in oncology, and have worked in oncology for 21 years. I also worked in hospice for 11 years, was a certified nursing assistant (CNA) for three years, and a licensed vocational nurse (LVN) for one year.

What was your first job out of college and how did you get into case management?

I was in a junior college career ladder program, so I worked nights as a CNA in med-surg acute care and then in a licensed vocational nursing (LVN) registry, mostly in ob/gyn, prior to graduation. My first job was as an RN in the oncology med-surg unit at Salinas Valley Memorial Hospital (now Health Care System) or the SVMHCS, and I am still there.

Has there been a defining moment in your career? Perhaps when you knew you were on the right road?

I thought I wanted to be a midwife when I started my nursing education, however, I did not like assisting births in the hospital with strangers. In my last year of working toward my associate degree in nursing (ADN), I met an amazing oncology instructor. At the same time, my best friend was dying of cancer, thus I became an oncology case manager.

More recently, I taught a CNA program for several years. In mid 2011 I attended a life directions seminar and was able to harness all of my passions and focus them around caregiving.

In brief, describe your organization.

SVMHCS is an acute care hospital with an average census of 166.

What are two or three important concepts or rules that you follow in case management?

  • The keys to successful utilization review and discharge planning and collaboration are communication, including written documentation and collaboration with the full team, including the patient, family, doctor, nursing staff and other providers.
  • Patients are assessed and educated within the first 24 to 48 hours of admissions.
  • Balanced self-care allows me to serve my team the best.
  • What is the single most successful thing that your organization is doing now?

    Expanding the role of case management to include p.m. shifts.

    Do you see a trend or path that you have to lock onto for 2012?

    Money talks and reimbursement has been the biggest challenge.

    What is the most satisfying thing about being a case manager?

    Treating patients and families with respect and kindness, especially at the end of life.

    What is the greatest challenge of case management, and how are you working to overcome this challenge?

    Finding services for obese or no pay source patients. SVMHCS case managers are working with management for creative sponsoring of needed services.

    What is the single most effective workflow, process, tool or form case managers are using today?

    Extended Care Information Network and executive health referrals.

    Where did you grow up?

    I was born in Los Angeles, CA, one of five girls and two surviving boys.

    What college did you attend? Is there a moment from that time that stands out?

    I attended Cabrillo Community College, Santa Cruz, CA for an advanced degree in nursing and a bachelor degree in public health nursing (PHN) at California State University at Dominguez Hills, CA. I enjoyed being of creative service in the community during my PHN clinicals; I used bilingual teaching tools to explain lab results, diet choices and I created new curriculum to introduce teens to human health by relating what they knew to horse health, disease, symptoms and interventions.

    Are you married? Do you have children?

    I have a husband of twelve years, a forty year old son and a six year old granddaughter.

    What is your favorite hobby and how did it develop in your life?

    The very first profession I fell in love with was a veterinarian, but my parents told me I was not smart enough to be a vet. So then I wanted to be a dancer, but my parents told me I couldn’t do that because if I broke my leg, I couldn’t support myself. So, now, I am a dancing nurse with six dogs!

    Is there a book you recently read or movie you saw that you would recommend?

    A book I wrote: The Heart of Caregiving, A Guide to Joyful Caring.

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