When Congress debated the Affordable Care Act in 2009, the legislation originally included a provision that would have allowed Medicare to reimburse doctors when they meet with patients to talk about end-of-life care.
But then Sarah Palin argued that such payments would lead to care being withheld from the elderly and disabled. Her comment ignited a firestorm among conservatives and helped fuel the opposition to the legislation.
Her assertions greatly distressed Dr. Pamelyn Close, a palliative care specialist in Los Angeles.
“It did terrible damage to the concept of having this conversation,” she said.
Amid the ensuing political uproar, Congress deleted the provision. And the lack of payments and concerns about the controversy further discouraged doctors from initiating these talks, according to Close.
“We just are not having these conversations often enough and soon enough,” Close said. “Loved ones who are trying to do always the right thing, end up being weighed with tremendous guilt and tremendous uncertainty without having had that conversation.”
When done right, according to Close, these counseling sessions often delve into end-of-life treatment options and legal documents, such as advance directives and living wills. The issues to be covered are complex and typically require a series of discussions.
Right now, Medicare only pays doctors for this sort of advanced care planning if it happens during the first visit for new Medicare enrollees. But the government recently has again proposed that Medicare reimburse doctors for including these conversations in their practice, whenever they occur.
Already, some private insurance companies are starting to do just that.
Meanwhile, the Alliance Defending Freedom, a conservative Christian organization, has formally opposed Medicare’s proposal.
“By paying doctors for these conversations, what we’re doing is opening the door to directive counseling and coercion,” said Catherine Glenn Foster, an attorney with the group. Foster says her organization supports end-of-life counseling and planning, but not in a doctor’s office.
“A doctor is not really the person you’d want to be having it with – particularly not a general practitioner who would not be able to advise on the nuances of end-of-life care in the first place,” she says.
But patients seem to want these talks. A 2012 study by the California HealthCare Foundation found that 80 percent of Californians would like to have an end-of-life conversation with their physician, but fewer than one in 10 has done so.
Many doctors who initiate the discussions often do so on their own dime. More often, they don’t have them at all, said Dr. Daniel Stone, an internist with Cedars-Sinai Medical Center in Los Angeles.
“When a doctor has patients scheduled every 15 minutes, it’s difficult to have a face-to-face conversation about values and goals related to the end of life, which is one of the most sensitive topics that you can possibly discuss with a patient,” Stone said.
Dr. Susan Tolle, an internist with the Center for Ethics in Health Care at the Oregon Health and Science University in Portland, says the informality with which such conversations are held now means that family members may not be included. Having the discussion as part of a formal doctor’s appointment can change that, she said.
“What it does is, it gives this really important conversation dignity and standing,” she said.
In Oregon, doctors have been squeezing end-of-life discussions into regular medical appointments for decades, under less-than-ideal circumstances. Over the last five years a quarter of a million Oregonians filed their wishes with a state registry. They use what’s known as a POLST form, which stands for Physician Orders for Life Sustaining Treatment. A version of it has been adopted by some other states, including New York and West Virginia.
Jo Ann Farwell, a retired Portland social worker who was recently diagnosed with a brain tumor, completed the form after talking to her doctor.
“I had surgery and had a prognosis of four to six months to live,” she said, after she was diagnosed with a brain tumor.
She did it, she said, to make sure her last hours are as comfortable as possible.
“I wouldn’t want to be on tube-feeding,” she said. “I wouldn’t want to be resuscitated, or have mechanical ventilation, because that would probably prolong my dying, rather than giving me quality of life.”
In the 1990s, health care workers all over Oregon recognized that the wishes of patients weren’t being consistently followed. So the health care establishment worked with the state and with ethicists to prioritize end-of-life talks; the result was the POLST form.
Rep. Earl Blumenauer, a Democrat from Portland, has introduced the Medicare reimbursement legislation every session since 2009. Until now, he says, the federal government hasn’t placed any value on helping people prepare for death, and he finds that ironic.
“The Medicare program will pay for literally thousands of medical procedures, many of them very expensive and complex, even if the person is at the latest stage of life and it may not do any good,” Blumenauer says.
From a purely financial point of view, the change could save money. But Blumenauer says that’s not what’s driving him.
“I don’t care what people decide,” he says. “If they want to die in an ICU with tubes up their nose, that’s their choice. What we want is that people know what their choices are.”
Farwell, the brain tumor patient, well remembers when her sister was dying from cancer.
“She never talked about death or dying,” Farwell said, “never talked about what she wanted at the end. It was very, very difficult for me to try to plan and give her care.”
Farwell wants her sons to be in a better position when it comes to carrying out her wishes.
The federal government is now accepting public comment on the Medicare reimbursement proposal. It’s expected to make a decision in November.
This story is part of a partnership that includes with KPCC, Oregon Public Broadcasting, NPR and Kaiser Health News.
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Chairwoman of hawk-i: Is Iowa’s Medicaid privatization legal?
The chairwoman of a state program that provides health insurance to children of poor families is questioning whether Iowa has acted legally with efforts to privatize management of the system. At issue is a $111.3 million annual program known as hawk-i that provides health insurance for more than 37,000 children from low-income families in Iowa. The program’s management will shift to private companies as part of Gov. Terry Branstad’s effort to privatize oversight of the state’s annual $4.2 billion Medicaid budget. (Des Moines Register)
UI Children’s Hospital construction price rises with upgrades
The 507,000 square feet of new construction, plus 56,250 square feet of renovated space, originally was budgeted to cost $292 million, to be paid through bonds, patient revenue and gifts. Safety updates, clinical upgrades, patient environment enhancements and construction considerations have pushed that total upward of $360 million. Construction is on track to finish in fall 2016, with occupancy slated for that winter. The extra $68 million to pay for it will come from hospital revenue bond proceeds and gifts — not taxpayers. (Cedar Rapids Gazette)
Business conditions weaken again in Iowa, Midwest
Business conditions in Iowa and eight other Midwestern states weakened again in July, according to a monthly survey by Creighton University’s Economic Forecasting Group. The August Business Conditions Index, which ranges between 0 and 100, declined to 49.6 from July’s 50.6, slipping below growth neutral. Ernie Goss, director of Creighton’s Institute for Economic Inquiry, said the index is pointing to weak, and potentially negative growth through the fourth quarter of 2015. (Cedar Rapids Gazette)
Iowa cities rank in top 20 safest-driving cities
A study just released by Allstate Insurance shows that Cedar Rapids and Des Moines have the fewest vehicle collisions in a ranking of America’s 200 largest cities. Cedar Rapids is listed as the seventh safest-driving city, improving from its 2014 ranking at 11th place. Des Moines is listed as the 19th safest-driving city, falling from its 2014 spot as the 13th safest city. (KCCI)
Fewer Americans skipping medical care for cost reasons
During the first three months of the year, just 1 in 20 Americans said they did not get medical care they needed because they could not afford it, according to the U.S. Centers for Disease Control and Prevention. The findings, from the federal National Health Interview Survey, show that 4.4 percent of people interviewed from January through March said they had skipped medical care in the previous year because of its cost — the lowest percentage in 16 years. The percent skipping care for cost reasons had reached nearly 7 percent in 2009 and 2010 and has been shrinking since then. (Washington Post)
How a new program could attract more rural health workers
The Indiana Statewide Rural Health Network is launching a new program to help rural hospital’s fill critical needs for allied health workers. A recent survey with the groups 30 participating hospitals found that nearly a third of them are having difficulty filing positions that require licensed and properly trained allied health workers—like ultrasound techs and lab technicians. Don Kelso, IRHA executive director, says that it was only anecdotally that they decided to survey the hospitals about job vacancies and were surprised to see so many positions that needed to be filled. (Indiana Public Media)
Lawmakers: New Jersey needs more psych beds
In New Jersey, when patients arrive in a hospital emergency department in a mental health crisis, chances are awfully good they will be there for several days — and sometimes weeks — waiting for a short-term psychiatric bed. In South Jersey, the shortage is so bad that the CEOs of five competing health systems have organized a collaborative to study the issue. This year, legislators held three roundtable discussions with health care providers in each part of the state to ask about the problem. (Cherry Hill Courier-Post)
Texas strives to lure mental health providers to rural counties
Of the 254 counties in Texas, 185 have no psychiatrist, according to Travis Singleton, who tracks physician shortages for Merritt Hawkins, a Texas-based consulting firm. “That’s almost 3.2 million [people],” he says. The shortage goes beyond Texas. In the past year, Singleton’s firm has been asked to recruit more psychiatrists nationwide than ever before. “While we knew the demand was high, I don’t think anyone expected it to that extent,” he says. (Iowa Public Radio)
Virginia jail death highlights importance of addressing nation’s mental health crisis
Jamycheal Mitchell was arrested in April for allegedly stealing $5 in groceries from a 7-Eleven, including a Zebra Cake, Mountain Dew, and a Snickers bar, according to The Guardian. His family told the news site that he suffered from bipolar disorder and schizophrenia, and had refused to eat and take his medication. He was supposed to be moved to a state-run mental health facility, but the transfer got stuck in government red tape and he remained in jail, the report notes. (NewsOne)
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Branstad defends Medicaid bid process
Gov. Terry Branstad is downplaying controversies experienced by four companies selected to manage Iowa’s $4.2 billion Medicaid program, and he says he’s hopeful disputes over the bidding process won’t delay the implementation of their oversight of health care for 560,000 poor and disabled persons. The four winning bidders – Amerigroup, UnitedHealthcare, WellCare and AmeriHealth – have each faced serious charges of fraud or mismanagement in other states with some forced to pay hundreds of millions of dollars in fines, a Des Moines Register investigation has found. (Des Moines Register)
Lucas County hospital affiliates with UnityPoint Health – Des Moines
The board of trustees of Lucas County Health Center announced Friday it has approved a new affiliation with UnityPoint Health – Des Moines, a senior affiliate of UnityPoint Health. The agreement, effective Sept. 1, provides hospital management and consultation services and also includes the necessary affiliation services for the health center to maintain its status as a rural Critical Access Hospital. (Des Moines Business Record)
Senator Grassley says Medicare reimbursement tilt leads to less psychiatrists
Last week’s rampage that saw a mentally-ill Virginia man fatally shoot two former co-workers on live TV is raising new calls for increased funding to identify and treat such people before they become killers. Iowa Senator Chuck Grassley says we can spend more money on mental health care but it doesn’t do any good if there aren’t professionals in place to deliver the help. “We have a dearth of psychologists and psychiatrists,” Grassley says. (Radio Iowa)
Age is just a number for this Ottumwa paramedic
We’ve all heard the saying, “Choose a job you love and you’ll never have to work a day in your life.” Easier said than done and seems to happen to a fortunate few, but Steve West is one of those folks who have done just that. As an ORMIC for Ottumwa Regional Health Center, Steve (at 74 years old) may also be one of the oldest active paramedics in Iowa and in the United States. “As long as I can contribute to the team and help, I will be here,” Steve says. “I like to be busy! The hospital has been good to me and good to this community.” (Ottumwa Courier)
CMS delays two-midnight rule enforcement to January 2016
The Centers for Medicare & Medicaid services on Wednesday said it would delay enforcement of the controversial two-midnight rule until the beginning of 2016, a change from the September 30 extension laid out in the sustainable growth rate replacement legislation passed by Congress in July. According to CMS, newly established quality improvement organizations will begin conducting reviews of short-stay inpatient claims on Jan. 1, 2016, a job that was previously conducted by Medicare Administrative Contractors. (Healthcare Finance News)
Data transparency: What the numbers don’t tell us about quality health care
We urge transparency in patient safety information and discuss the need for “evidence based medicine” incessantly. But what is full disclosure and is it healthy? Every type of company has truckloads of data, be it market data, polling data or public opinion data. Health care also has millions of data bytes that can reflect everything from volume and financial metrics to outcomes, including survival and complications. Reports can be written to pull pieces out here and there, but the challenge comes from putting individual data points together to tell any kind of meaningful story. (U.S. News & World Report)
Brigham and Women’s to cut 100 jobs as costs rise faster than revenues
Brigham and Women’s Hospital plans to cut 100 positions to save $10 million as costs rise faster than revenues, hospital officials said Monday. The cuts, taking effect over several months, will include both layoffs and leaving vacant positions unfilled. They will apply to all jobs that do not deal in direct patient care. No doctors, nurses, or other staff who work directly with patients will be laid off, hospital officials said. The Brigham also has frozen hiring for non-patient care positions. (Boston Globe)
Texas to reimburse for school-based telehealth services
Starting September 1, 2015, the Texas Medicaid program will reimburse physicians for providing school-based telemedicine visits for children enrolled in primary or secondary schools. The new telemedicine program was authorized by Texas House Bill (HB) 1878, which was signed into law on June 16, 2015. The provisions of HB 1878 are based on a pilot program conducted in 2014 by Children’s Health System of Texas in 27 schools in North Texas. The 2014 pilot was funded through the state’s Medicaid 1115 waiver to allow school nurses to connect with physicians from Children’s Health Pediatric Group clinics through a video consultation. (Open Minds)
Mercy Health, Premier partner to advance population health
Mercy Health, Ohio’s largest health system, has expanded its relationship with healthcare improvement company Premier. The action follows savings of more than $117 million attributed to supply chain, business intelligence and performance improvement solutions. This week, Premier announced the two will focus on advancing Mercy’s population health management, with an eye toward improving care for chronically-ill patients. (Healthcare Dive)
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How does privatizing Medicaid save Iowa money?
I am concerned about the privatization of Medicaid Services in Iowa in general, and in particular the hiring of out-of-state companies to manage the mental health benefit program. I was even more concerned when the Register published that all three of the companies contracted have records of fraud or mishandling claims. I was also taken aback by the information that the previous management company received nearly 10 percent of the total Medicaid budget for managing. (Des Moines Register)
The heroin epidemic: ‘Worse than a sickness’
Heroin’s new hold into Cedar Rapids slipped in quietly, according to one emergency department doctor. UnityPoint Health-St. Luke’s Hospital’s emergency department already has treated more heroin overdoses during the first half of this year than in all of 2014 — 20 from January to June 2015 compared with 19 in 2014. It treated only nine in 2010. (Cedar Rapids Gazette)
Some schools working with parents to address mental illness
When a student’s mental health care requires more than a typical school counselor can provide, where do schools turn? In the Pleasant Valley Community School District in Eastern Iowa, they turn to a professional counselor contracted to work with students in need. “It’s a great partnership,” Pleasant Valley Assistant Superintendent Brian Strusz said. “It’s a win-win for everybody.” (Cedar Rapids Gazette)
A decline in dentists
Iowa’s dental work force looks very different from it did 18 years ago — with far more women practicing and the average age of working dentists steadily climbing. That’s according to new data in several issue briefs out by the University of Iowa’s Public Policy Center. The briefs laid out dentist-workforce supply trends in Iowa from 1997 to 2013 to help the UI’s College of Dentistry and Dental Clinics better anticipate potential shortages and focus retention and recruitment efforts. (Cedar Rapids Gazette)
As health care shifts to homes, need for home health aides grows
Baby boomers, as they grow older and more infirm, will need more people like Antwannette Hill – home health aides, and personal care aides – jobs that overlap, with the latter often doing more housekeeping. The U.S. Bureau of Labor Statistics says both categories will be among the fastest growing in the next seven years, adding just over a million jobs. Aging baby boomers are driving the demand for more health services, but how that care is delivered is not just about demographics. It’s also about who can do it more cheaply, said labor economist Paul Harrington, director of Drexel University’s Center for Labor Markets and Policy. (Philadelphia Inquirer)
A new way to think about conflicts of interest in medicine
Does the source of funding affect study findings? The question is at the heart of a longstanding debate about financial conflicts of interest in medicine and what to do about them. That debate was recently reinvigorated by a three-part series of articles on the subject in The New England Journal of Medicine. But other potential sources of conflicts of interest in medicine have not been as closely examined. (New York Times)
Precision medicine, linked to DNA, still too often misses
Back in January, when President Obama proposed a precision medicine initiative with a goal of “matching a cancer cure to our genetic code,” John Moore could have been its poster child. His main tumors were shrinking, and his cancer seemed to have stopped spreading because of a drug matched to the cancer’s DNA, just as Obama described. This summer, however, after a year’s reprieve, Moore, 54, feels sick every day. The cancer — advanced melanoma like former president Jimmy Carter’s — has spread to his lungs, and he talks about “dying in a couple of months.” (Boston Globe)
Organ donation awareness increases after IndyCar driver Justin Wilson’s death
The Indiana Donor Network said they’re seeing increased attention in the wake of IndyCar driver Justin Wilson’s death. This week we learned Wilson was an organ donor and saved six lives. Still Thursday, flowers remained outside Gate 1 at the Indianapolis Motor Speedway, along with memorials and mementos for fallen IndyCar driver Justin Wilson. But Wilson’s legacy lives on through organ donation. (Fox 59)
FDA warns tobacco makers about label language
The Food and Drug Administration issued warnings to the makers of Natural American Spirit, Winston and Nat Sherman cigarettes, saying that the brands could not be marketed as “additive-free” or “natural.” In three separate letters made public on Thursday, the F.D.A. told the manufacturers of the brands that they did not have the agency’s approval to claim that their products were free of certain harmful substances, or that they posed less risk to consumers than other tobacco products. (New York Times)
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Skiff provides $1.5 million in community benefits
Skiff Medical Center provides $1,513,610 in community benefits to Jasper County, according to a recently completed assessment of those programs and services. That amount, based on figures from the 2014 fiscal year, includes $1,236,131 in uncompensated care and $252,858 in free or discounted community benefits Skiff specifically implemented to help Jasper County residents. (Newton Daily News)
Memphis company defends psych hospital plan
A Memphis firm vigorously defended its plans to build a 72-bed psychiatric hospital in the Quad-Cities, saying Thursday that it can co-exist with the existing hospitals — and that competition will be good for patients and the community. A representative of Strategic Behavioral Health LLC spent an hour briefing the Scott County Board of Supervisors, answering questions and rebutting some of the allegations Genesis Health System officials made earlier this week while asking board members to oppose the plan. (Quad-City Times)
Ankeny running short on ambulances, calls on Polk City for help
It’s clear to see that Ankeny’s population is on the rise. Ankeny firefighter and President of the IAFF 4814, said, “The city is growing at such a high right now. I think we are adding five people a day right now.” That growth is beginning to spread the city fire department dangerously thin. “In 2013-14 call volume went up 15 percent which is on par with population over the last few years so that’s not going to slow down,” said Wells. Earlier this month Polk City which has a mutual aid contract with Ankeny, was needed to respond to fifteen medical emergencies in just thirteen days, all in Ankeny. (WHO-TV)
Commit to be fit: It really is better to give than to receive
During our 2014 “Year in Review,” my mom asked each of us to come up with one word we would like to focus on for the new year. I remember straining my brain trying to come up with the perfect word. All these powerful words flashed in my mind: determined, focused, successful, willpower, motivated, strong, empower, perseverance. Each of my family members named similar — if not the same — words that I listed above. We ended with my youngest brother — and I’ll never forget it. His word was the total opposite of what the rest of us had chosen — and unlike anyone else, he didn’t give a lengthy reason of why he chose his word. He just simply said: “Others.” (Cedar Rapids Gazette)
More than 80% of health care IT leaders say their systems have been compromised
Eighty-one percent of health care executives say their organizations have been compromised by at least one malware, botnet or other kind of cyberattack during the past two years, according to a survey by KPMG. The KPMG report also states that only half of those executives feel that they are adequately prepared to prevent future attacks. The attacks place sensitive patient data at risk of exposure, KPMG said. The 2015 KPMG Healthcare Cybersecurity Survey polled 223 CIOs, CTOs, chief security officers and chief compliance officers at healthcare providers and health plans. Sixty-six percent of the IT executives at healthcare plans who were surveyed said they were prepared to fend off attacks. (Computerworld)
Population health initiatives drive hospital collaboration
The push for patient-centered care and improving population health has led to increased collaboration among hospitals, according to a nationwide survey from the American Hospital Association (AHA). About nine in 10 hospitals collaborate with other hospitals and seven in 10 participate in a regional collaborative on these initiatives, according to the survey of more than 1,400 hospitals conducted by the AHA’s Research & Educational Trust and the Association for Community Health Improvement, in partnership with the Public Health Institute. (Fierce Healthcare)
L.A.’s westside mystery: Higher cancer rates in one zip code, longer lives in another
Two programs — one conducted by the University of Southern California, the other by best-selling “Blue Zones” author Dan Buettner — have revealed odd stats. While cancer rates are up in places like Beverly Hills and Pacific Palisades, the Beach cities (Hermosa, Manhattan, Redondo) are working toward longer-than-average life spans. (Hollywood Reporter)
RecycleHealth finds unused activity trackers new homes with underserved populations
Last year when Endeavor Partners published a study showing that a third of wearable activity tracker users consign their device to the sock drawer within six months, most people saw it as a fatal flaw in the activity tracker trend. But Lisa Gualtieri, an assistant professor of Public Health and Community Medicine at Tufts University, saw it as an opportunity. “You can recycle cellphones, you can recycle your glasses, you can recycle used tennis balls,” Gualtieri said. (Mobi Health News)