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FEBRUARY 11, 2009

NIH spending less on pain research
Pain research accounts for about 0.6% of all grant awards by the National Institutes of Health, according to a study published in The Journal of Pain. Funding levels rose 12% from 2003 to 2004 but then dropped by 9.4% on average during the subsequent three years. Funding for cancer pain research declined more rapidly for basic science than for clinical pain research. The authors called the investment in pain research "seriously out of scale with the impact of pain on the nation's health care burden." The authors indicate funding for pain research has declined at a higher percentage than the overall NIH budget. At the same time, NIH grants increased steadily for investigations pertaining to nausea and dyspnea. The American Pain Society provided a grant to support the research. http://www.jpain.org/article/PIIS1526590008007682/fulltext

Medical schools developing more humanistic faculty
A recent paper published in the January issue of Academic Medicine reports on the design and implementation of a professional development curriculum in five medical schools. The objective was to create more humanistic educators, by enhancing faculty members' humanistic skills, such as compassionate, skillful communication and belief in human interests, values and dignities, valuable qualities for clinicians delivering palliative care to possess. Thirty-four educators completed the program. Researchers compared feedback from medical students and residents taught by the trained participants and a control group and found those educators who completed the curriculum scored higher on the Humanistic Teaching Practices Effectiveness Questionnaire than the other faculty. http://journals.lww.com/academicmedicine...

Demystifying coding: Comprehensive training for coding, OASIS and therapy interactions
The Association of Home Care Coders will present seminars in Nashville, Boston and Atlanta to inform providers about coding basics, such as sequencing case-mix rules and unraveling rules. Other sessions will go beyond the basics to discuss proven strategies for coding complex conditions and complicated combinations. Other sessions, offered in select cities, will discuss OASIS, clinical record keeping, identifying high-risk factors, and the new prospective payment system rules. In Nashville, participants will learn how the Centers for Medicare & Medicaid Services have turned therapy into gold, and how to properly document, and to paint the picture of a patient's health to improve outcomes and receive proper reimbursement. http://www.homecarecoders.org/2009Training/agenda.html

South Carolina to cut Medicaid funds for hospice care
Citing revenue shortfalls and budget cuts, the South Carolina Department of Health and Human Services announced substantial service changes to its Medicaid program, including the elimination of the hospice benefit, effective at the end of this month. Hospices have been notified to stop accepting new referrals. The department ruled that dual eligible recipients enrolled in hospice through another payor source and a Medicaid Waiver program must choose between hospice and the waiver program. Patients will no longer be able to participate in both programs simultaneously. The state will also limit physician visits to 12 per year, discontinue coverage for all group physical and occupational therapy, and limit laboratory and radiological testing. http://www.dhhs.state.sc.us/Internet/pdf...

Dealing with existential or psychological pain
A paper from the Catholic University of America - Columbus School of Law examines the issue of existential or psychological pain and how hospices deal with such pain, and suggests that terminal or deep sedation should be more widely embraced as a medically sound and compassionate response to refractory pain, even if the drug has a secondary effect of hastening death. The author, George P. Smith II, concludes that management of death can surely be both more humane and more efficient when the principle of medical utility is harmonized with patient autonomy. http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1166384

Hospices struggle with chemotherapy costs
With many oncologists prescribing newer, less toxic, oral chemotherapy agents for palliation and to improve patients' quality of life, hospices across the country are struggling with whether to pay for drugs, such as Iressa and Xeloda. Gail Austin Cooney, MD, medical director emeritus of the Hospice of Palm Beach County Inc., in West Palm Beach, Fla., told Florida Medical Business, "The new pharmaceuticals are often very expensive, but we have a commitment as an organization to offer palliative chemotherapy to patients." Not all hospices agree, with some taking the position that the drugs fail to effectively reduce symptoms on their own and others believing their use is inconsistent with the hospice philosophy. The National Hospice and Palliative Care Organization supports the use of palliative chemotherapy and believes offering it may allow early access to hospice care and additional revenue from the earlier admissions could offset the extra cost, said Stephen Connor, vice president for research and international programs for NHPCO.

"Calculate" palliative care's potential effect on your hospital
The Center to Advance Palliative Care's Impact Calculator allows hospitals to estimate the financial savings a palliative care program could generate. The user enters data, such as average length of stay, average cost per day, number of beds at the institution, the occupancy rate, number of discharges and the number of deaths annually. The calculator then provides the potential annual savings and annual volume of patients likely to need palliative care, based on other programs' experiences. The data serve as a starting point for further analysis. The Advanced Impact Calculator, also free of charge from CAPC, lets hospitals estimate cost-per-day savings, direct costs and an estimated cost savings after referral to a palliative care program. http://www.capc.org/impact_calculator_basic/

Washington State hospices embrace CAM
A Bastyr University Research Center-led study found that 86% of Washington State hospices offered patients complementary and alternative (CAM) therapeutic modalities, even though these services were not covered under hospice benefits. Volunteers and small donations allowed the hospices to provide CAM care. Of those offering these services, 87% provided massage, 74% music therapy, 65% energy healing, 45% aromatherapy, 45% guided imagery, 42% compassionate touch, 32% acupuncture, 32% pet therapy, 29% meditation, 22% art therapy, 19% reflexology and 16% hypnotherapy. http://ajh.sagepub.com/cgi/content/abstract/25/6/463

Palliative Care Meeting slated for June 2009 in Hamilton, Ontario
McMaster University in Hamilton, Ontario, will present "5 Days in Palliative Care: An In Depth Learning Experience" from June 15-19, 2009, at the Bagnall Lodge Conference Center in Canterbury Hills, Ancaster, Ontario. Sessions are designed to enhance health care professionals' collaborative practice skills and knowledge about palliative care. Participants will learn about assessing patients' needs and managing their physical, emotional, social, and spiritual distress. The conference will offer opportunities to forge new professional relationships while attendees learn about hospice and palliative philosophies, fostering dignity, easing fatigue, and managing pain and dyspnea. Topics also include bereavement care, funeral planning, legal issues, and the role of organ donation. http://www-fhs.mcmaster.ca/conted...

MedPAC votes to revise the hospice payment system
The Medicare Payment Advisory Commission, at its January meeting, approved staff recommendations that dealt with hospices and aimed to address concerns about increased lengths of stay creating incentives for hospices, since higher Medicare margins occur with longer-term patients. Staff sought to provide effective controls that would prevent length of stay from increasing and adding to Medicare's costs. The proposed changes will include reforming payment systems, such as setting payments higher at the start of an episode then having them decline over time; improving accountability and oversight; and standardizing cost reports and claims data. http://www.medpac.gov/transcripts/0108-0109MedPAC.final.pdf

People on the Move
R. Sean Morrison, MD, Director, National Palliative Care Research Center and Professor of Geriatrics and Medicine, Mount Sinai School of Medicine, New York, is the new president-elect of the American Academy of Hospice and Palliative Medicine…Barbara Monroe, Chief Executive of the flagship St. Christopher's Hospice in London has been awarded the title of Honorary Professor by Lancaster University's International Observatory on End of Life Care…Later this month Robert A. Fried, MD will start a new position as Medical Director of Palliative Care and Hospice Services at NorthShore University HealthSystem in the Chicago area…Tammie E. Quest, MD of Emory University was just named Chief of the Section of Hospice and Palliative Medicine at the VA in Atlanta, GA…Tomas P. Owens, MD was appointed Medical Director of Palliative Care Services at INTEGRIS Baptist Medical Center, Oklahoma City, OK…Regenia Jones, RN, MSN, has been appointed administrator for Hospice of Southwest Georgia, which services several counties in south Georgia…Please send your People on the Move news to:  Briefings@liebertpub.com

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