iLoveBenefits: Industry News Blog

Educating patients and families on palliative vs hospice care is critical

Medicare Spent $11,393 per Hospice Beneficiary in 2014

 

CMS recently released an analysis on hospice spending. Here are some key findings from the report:

 

In 2014, Medicare spent an average of $11,393 per hospice beneficiary.
There were 1.3 million hospice beneficiaries in 2014.
11% had a live discharge from hospice care in 2014.
In 2014, 1 in 3 beneficiaries had more than 60 days of hospice care.
13% had more than 180 days of hospice care in 2014.
South Carolina had the highest spending ($14,778) per hospice beneficiary.

 

 

Source: CMS, October 6, 2016

Provider should follow the wishes of the patient their caregiver(s)

Survey shows many people get unwanted, excessive careA survey of 1,007 adults ages 50 and older found 12% reported they or a family member had experienced unwanted medical care and 19% categorized treatments they or a family member had received as excessive. The study, sponsored by the nonprofit group Compassion & Choices, found 82% said it was very important to honor end-of-life medical wishes, and 50% supported withholding physician or facility pay if treatments did not adhere to those decisions. Healio (free registration) (7/31)

The presence of palliative care teams in growing in hospitals

According to  the Center to Advance Palliative Care (CAPC) palliative care in U.S. hospitals has increased for the 11th consecutive year. The number of hospitals with a palliative care team increased from 658 (24.5%) to 1,635 (65.7%)-a steady 148.5% increase from 2000-2010.

Large hospitals are more likely to have a team. (87.9% of hospitals with 300 or more beds have a team compared to 56.5% of hospitals with 50-299 beds.) The Northeast has the greatest growth and the highest prevalence. (75.8% of hospitals in 2012 compared to 73% in 2011.) The South shows some growth, but still has the lowest prevalence. (52.7% of hospitals in 2012 compared to 51% in 2011.)

Source: Center to Advance Palliative Care (CAPC)
http://www.capc.org/news-and-events/releases/08-27-12

August 30, 2012 | Categories: healthcare,hospitals | Tags: , , | Comments (0)

End of Life – one of the most difficult subjects

These contributions from the Commonwealth Fund are helpful documents and videos around a very difficult subject – end of life.

Improving Care at the End of Life

As patients live longer, many states, community-based coalitions, and health care providers have begun to focus on the quality—and quantity—of medical care provided at the end of life. The resulting programs have provided physicians with techniques for delivering bad news, managing transitions to palliative care, and handling requests for therapies that are likely to be futile. They’ve also helped to elicit patient preferences, leading to lower utilization in some locations. [Read more]

Using Videos to Help Patients Plan End-of-Life Care

A series of videos developed by a multidisciplinary team of clinicians that includes ethicists and palliative care doctors helps patients understand the risks and benefits of various end-of-life treatments. Designed for patients facing advanced dementia, cancer, and heart disease among many other conditions, the videos capture the experiences of actual patients to illustrate the trajectory of diseases or conditions and spark conversation among physicians, patients, and their caregivers about advanced care planning. [Read more]

What most of need . . . a little more attention . . . especially as we age

Loneliness, social isolation raise risk of early death
Older patients who reported being lonely had a higher risk of dying over the six-year study period than those who did not report loneliness, according to new research. Another study revealed that heart disease patients who lived alone had higher risk of cardiovascular death and all-cause death than those living with other people. “This should send up a little red flag that maybe this patient needs a little bit more attention,” said Dr. Deepak Bhatt, a researcher on the latter study. “Maybe we need to be a little more careful that this patient really does go to fill their prescription.” The findings appear in the Archives of Internal Medicine. Nurse.com (6/18),

Following patient preferences are as important as knowing and understanding them

According to a recent California survey:

  • 82% said that it is important to put their end-of-life medical treatment wishes in writing, but less than one quarter have actually done so
  • Only 44% of Californians who have lost a loved one in the last 12 months say their loved one’s end-of-life preferences were completely followed and honored by medical providers
  • These numbers drop to 26% for those whose loved ones experienced a language barrier and 25% for those who were uninsured at the time of death

Source: “Poll Finds Wide Gap Between the Care Patients Want and Receive at End of Life,” California Healthcare Foundation Press Release, February 14, 2012, http://www.chcf.org/media/press-releases/2012/end-of-life-care


Many elderly heart patients opt for longevity over quality of life, half want resuscitation: study

End-of-life preferences of elderly patients with chronic heart failure

Eur Heart J (2011) doi: 10.1093/eurheartj/ehr404 First published online: November 8, 2011
  1. Hans-Peter Brunner-La Rocca1,2,*,
  2. Peter Rickenbacher3,
  3. Stefano Muzzarelli1,
  4. Ruth Schindler1,
  5. Micha T. Maeder4,
  6. Urs Jeker5,
  7. Wolfgang Kiowski6,
  8. Marcia E. Leventhal7,
  9. Otmar Pfister1,
  10. Stefan Osswald1,
  11. Matthias E. Pfisterer1,
  12. Hans Rickli4 and
  13. for the TIME-CHF Investigators

+ Author Affiliations

 

  1. 1Department of Cardiology, University Hospital Basel, Basel, Switzerland

  2. 2Department of Cardiology, Maastricht University Medical Centre (MUMC), Cardiovascular Research Institute (CARIM), PO Box 5800, NL-6202 AZ Maastricht, The Netherlands

  3. 3Department of Cardiology, University Hospital Bruderholz, Bruderholz, Switzerland

  4. 4Department of Cardiology, Kantonsspital St Gallen, St Gallen, Switzerland

  5. 5Department of Cardiology, Kantonsspital Lucerne, Lucerne, Switzerland

  6. 6HerzGefässZentrum, Klinik Im Park, Zurich, Switzerland

  7. 7Department of Nursing, University Hospital Berne, Berne, Switzerland

Abstract

Aims Elderly heart failure (HF) patients are assumed to prefer improved quality of life over longevity, but sufficient data are lacking. Therefore, we assessed the willingness to trade survival time for quality-of-life (QoL) and the preferences for resuscitation.

Methods and results At baseline and after 12 and 18 months, 622 HF patients aged ≥60 years (77 ± 8 years, 74% NYHA-class ≥III) participating in the Trial of Intensified vs. standard Medical therapy in Elderly patients with Congestive Heart Failure had prospective evaluation of end-of-life preferences by answering trade-off questions (willingness to accept a shorter life span in return for living without symptoms) and preferences for resuscitation if necessary. The time trade-off question was answered by 555 patients (89%), 74% of whom were not willing to trade survival time for improved QoL. This proportion increased over time (Month 12: 85%, Month 18: 87%, P < 0.001). In multivariable analysis, willingness to trade survival time increased with age, female sex, a reduced Duke Activity Status Index, Geriatric Depression Score, and history of gout, exercise intolerance, constipation and oedema, but even combining these variables did not result in reliable prediction. Of 603 (97%) patients expressing their resuscitation preference, 51% wished resuscitation, 39% did not, and 10% were undecided, with little changes over time. In 430 patients resuscitation orders were known; they differed from patients’ preferences 32% of the time. End-of-life preferences were not correlated to 18-month outcome.

Conclusion Elderly HF patients are willing to address their end-of-life preferences. The majority prefers longevity over QoL and half wished resuscitation if necessary. Prediction of individual preferences was inaccurate. Trial Registration: isrctn.org Identifier: ISRCTN43596477

When patient’s end of life wishes are followed

When the patient and the physician both signed an advance directive form which outlined the options and use of breathing or feeding assistance, resuscitation wishes were honored 98% of the time, and orders to limit medical interventions were honored 91.1% of the time, according to a recent study.

Source: “The Consistency Between Treatments Provided to Nursing Facility Residents and Orders on the Physician Orders for Life-Sustaining Treatment Form,” Journal of the American Geriatrics Society, abstract only, October 22, 2011, http://onlinelibrary.wiley.com/doi/10.1111/j.1532-5415.2011.03656.x/abstract

November 9, 2011 | Categories: healthcare,quality | Tags: , | Comments (0)

Medicare Patients Seeing 10 or More Doctors within last six months of life



According to a new study of Medicare beneficiaries published by the Dartmouth Institute for Health Policy and Clinical Practice, overall, chronically ill patients were significantly more likely to be treated by 10 or more doctors in the last six months of life in 2007 than they were in 2003, as the national rate increased from 30.8 percent to 36.1 percent. In 2007, patients in Royal Oak, Mich. received the most intensive care by this measure, with 58.1 percent of patients seeing 10 or more doctors in the last six months of life. Other regions with high rates included Ridgewood, N.J. (57.6%) and Philadelphia (57.2%). Regions with low rates included Boise, Idaho (14.2%), Salt Lake City (15.0%) and Medford, Ore. (16.4%).

From 2003 to 2007, among the 35 academic medical centers for which data are available, 22 had increases in the percentage of patients seeing 10 or more doctors in the last six months of life. Emory University Hospital saw the largest growth in this rate, from 40.4 percent to 63.2 percent, while the University of North Carolina Hospitals in Chapel Hill had the largest decrease, from 45.0 percent to 35.2 percent. In 2003, the likelihood that a patient at Emory University Hospital would see 10 or more doctors was similar to that for a patient at the University of North Carolina Hospitals. But over the next five years, the percentage of patients seeing 10 or more doctors increased 22.8 percentage points at Emory, while the percentage dropped 9.8 percentage points at UNC Hospitals.

Source: The Dartmouth Institute for Health Policy and Clinical Practice. “Trends and Variation in End-of-Life Care for Medicare Beneficiaries with Severe Chronic Illness.” April 12, 2011.  http://www.rwjf.org/files/research/72192april2011.pdf

 

Medicare patient hospital days trend lower during last six months of life

Editor’s note: With growing emphasis on patient and caregiver communications along with palliative care initiatives the number of days spent in hospitals in the last six months of life appears to be trending downward. However, wide variation continues to exist depending on where you live.

 
According to a new study on Medicare beneficiaries published by the Dartmouth Institute for Health Policy and Clinical Practice, overall, the average patient spent slightly fewer days in the hospital during the last six months of life in 2007 than in 2003, as the national rate dropped from 11.3 to 10.9 hospital days per patient. In 2007, chronically ill patients in Manhattan spent, on average, 20.6 days in the hospital during their last six months of life, almost four times more than patients in Ogden, Utah, where the average was 5.2 days.

Among those academic medical centers where patients spent less time in the hospital in 2007 than in 2003 were the University of Texas Medical Branch Hospitals in Galveston (-5.0 days), the University of Iowa Hospitals and Clinics in Iowa City (-5.0 days) and Tufts-New England Medical Center in Boston (-4.6 days). Ten academic medical centers had increases of at least two days, including Hahnemann University Hospital in Philadelphia (+6.8 days).
 
Source: The Dartmouth Institute for Health Policy and Clinical Practice. “Trends and Variation in End-of-Life Care for Medicare Beneficiaries with Severe Chronic Illness.” April 12, 2011.  http://www.rwjf.org/files/research/72192april2011.pdf

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