Hospice eNews

What the Media Said about End-of-Life Care This Week

Week of May 30, 2005

…a service of Florida Hospices and Palliative Care

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CMS PROPOSES NEW HOSPICE CONDITIONS OF PARTICIPATION

CMS has proposed a new rule aimed at improving the care given to the more than 700,000 Medicare hospice beneficiaries. The new conditions of participation (COPs) would “ease the regulatory burden for hospice providers and improve the quality of care for all hospice patients, including the expanding population of Medicare patients choosing this benefit,” the CMS press release said. The COPs also adopt “contemporary standards of practice in the hospice community” and incorporate recommendations from a number of groups, including the Secretary’s Advisory Committee on Regulatory Reform, the Office of Disability, Aging and Long-Term Care Policy, the Office of the Inspector General, Operation Restore Trust and the general public.

CMS Administrator Mark B. McClellan, MD, PhD, said, “Terminally ill patients choosing the hospice option are a high priority in our quality improvement efforts. This proposal will move us closer to our overall goal of high quality for all Medicare beneficiaries.” The CMS media release is online at www.cms.hhs.gov/media/press/release.asp?Counter=1469.

The last rule was written in 1983. The new proposal puts more attention on individual patients and their specific needs. Some of the new changes and additions include:

* Requiring a patient assessment to be sure that patients’ needs are identified in a timely way;

* “Replacing the quality assurance requirement with a more comprehensive quality assessment and performance improvement (QAPI)” COP “that enables hospices to take tailored proactive steps to ensure quality care;”

* Allowing hospices, in certain situations, to contract for core services;

* Removing the requirement that an RN provide patient care in an inpatient facility on a 24-hour basis, as recommended by the Secretary’s Advisory Committee on Regulatory Reform; and

* Adding “guidance” for hospices caring for nursing home residents.

NHPCO issued a release applauding the new rule and said that NHPCO staff and committee members were “actively reviewing the proposal. Additional resources and other links are also available on the NHPCO Website, in the “Inside NHPCO” section at www.nhpco.org/i4a/pages/Index.cfm?pageid=4574.

On June 1-2, the NHPCO Regulatory Subcommittee, the Hospice Association of America Advisory Board and invited guests will review the proposal in detail as they prepare to respond to the proposal. In addition, NHPCO has invited persons selected by state hospice organizations to a “Train the Trainer” session on June 9-10. Trainers will go home to provide information and comment sessions in each state. The NHPCO release notes that CMS has asked for an “industry-wide, coordinated response” and public comments will be accepted until July 27.

The COPs are available for download from the NHPCO site listed above or from the Federal Register site at www.gpoaccess.gov/fr/. Do a quick search on “hospice COP” without the quotes. (CMS Office of Media Affairs, 5/25; Federal Register, 5/27; NHPCO NewsBriefs, 5/26; NHPCO Press Release; 5/27; NHPCO website)

PAIN NOTES

* The discovery of morphine 200 years ago “ranks on the short list of groundbreaking medical advances, along with the discovery of ether, x-rays and blood types,” according to Dr. Jonathan Moss of the University of Chicago. Twenty-two-year-old Friedrich Serteuner’s paper about his discovery of poppy crystals, written in 1805, was ignored until he republished it 12 years later. The article traces the history and importance of morphine in pain management. (Chicago Tribune, 5/22)

* An editorial in a Massachusetts newspaper says that banning OxyContin from the commercial market, as proposed by US Representative Stephen F. Lynch (D-Massachusetts), “goes too far.” The writer says, “Abuse and illegitimate use of legally prescribed narcotics is a serious problem. But there are steps lawmakers can take short of an outright ban, which only should be a last resort.” (Telegram & Gazette, 5/24)

* Johnson & Johnson recently announced that it has 10-13 new medicines in the approval process by the end of 2007. The company wants two painkilling drugs approved in 2006 and has plans to file 70 applications with the FDA by 2011. Twenty-three of the applications are “for new medicines and the rest for new uses of existing drugs.” (Chicago Tribune, 5/27)

* Appropriators from the US House of Representatives want the FDA to speed approval of Schedule II painkillers, which are less addictive than drugs such as OxyContin. Committee members say quicker approval would “encourage development of safer drugs.” Patient and consumer advocates, however, have argued in the past that so-called accelerated approvals should only be given to drugs that treat serious or life-threatening illnesses. (FDA Week, 5/27)

PAS & EOL NOTES

* A preliminary draft of the 2006 Medicare handbook is being revised after members of Congress, advocates for beneficiaries, state insurance regulators and insurance companies all told the Bush administration that it had serious flaws. The new booklet will be mailed to Medicare recipients this fall. (The New York Times, 5/22)

* Polly Crouch, who is terminally ill with lung cancer, wants the California legislature to approve the physician-assisted suicide bill. She’s not afraid of death but is afraid of “losing mental clarity and ultimately dropping into a vegetative state.” The measure is supported by Oregon’s Compassion and Choices which said it received 26,000 telephone calls about the Schiavo case. (The Orange County Register, 5/21)

* According to his wife, David Pruett, the 42-year-old Oregonian who took his prescribed barbiturate overdose for his terminal lung cancer but woke up after a three-day sleep, says that God told him, “This is not the way to get into heaven.” The story has “fueled debate” over both the Oregon law and its proposed California counterpart. Pruett’s case is being investigated by the Oregon Board of Pharmacy. (Los Angeles Times, 5/24)

* A Scripps-Howard Texas Poll has found that the Schiavo case prompted 73% of Texans to discuss their end-of-life wishes with family members. Fifty-four percent of Texans do not have living wills, 77% would not want to be kept alive in a vegetative state and 52% would remove a loved one’s feeding tube in a case like Schiavo’s. Sixty-nine percent of Texas objected to Congress and President Bush intervening in the Schiavo case. (Corpus Christi Caller-Times, 5/21)

OTHER NOTES

* A recent FDA advisory says that treatment with “atypical antipsychotic drugs” may double the death rate of elderly patients with dementia. The advisory applies to olanzapine, aripiprazole, risperidone, quietapine, clozapine and ziprasidone. The advisory is online at www.fda.gov. Search on “antipsychotic elderly dementia” without the quotes. (JAMA, 2005;293:2462)

* A study conducted by University of South Florida Sarasota-Manatee has found that more than 50% of Manatee County caregivers who are over 65 are caring for their own parents. A report that gives a detailed profile of elderly poor people living in Sarasota and Manatee counties will be released shortly. The article is online at www.bradenton.com/mld/bradenton/11744164.htm. (The Herald, 5/26)

* The Dallas Morning News ran an article that answers the six most frequently asked hospice questions as identified by NHPCO: 1) Who qualifies for hospice?; 2) How can I afford it?; 3) In what places is the care given?; 4) What questions should I ask when choosing a hospice?; 5) What does hospice do for patients and families?, and 6) What is the role of volunteers? (Dallas Morning News, 5/22)

* A Dallas Morning News article notes that there were 1,200 hospice programs in 1992 and 3,300 in 2003. In the same time frame, the number of Medicare beneficiaries choosing hospice rose from 143,000 to 950,000, and Medicare hospice spending went from $1 billion to almost $6 billion. (Dallas Morning News, 5/22)

* Oslten, a temporary office service company, has joined Roto-Rooter in the hospice market, as has HCR Manor Care. The Progressive Populist article says hospices aren’t a bad investment. Since the ultimate mortality rate is 100%, there will always be a “steady stream of customers.” The author says that one troubling step in the “capitalization of health care,” is whether accountants will now sit at the table with other members of the caregiving teams. (Progressive Populist, 5/15)