The Hospice e-News

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

Week of March 27, 2006

…a service of Florida Hospices and Palliative Care

AUTHOR OFFERS MARKETING TIPS FOR HOSPICES

One of the biggest mistakes hospices can make in selling their services is overuse of the “soft sell,” which is a technique used to gain business “in the long run.” The author of a Home Health Line article, Samantha Joseph, says that people who call hospices don’t often want business “in the long run.” They usually have a specific problem that needs immediate attention – they need end-of-life care for a friend or relative. To get the referral, Joseph suggests some specific ways to deal with callers.

* Engage callers and probe for details. Focused questions will help the staff to elicit information.

* Seek more information about the patient and ask the caller to tell you about his/her situation. To get more information on how the caller is handling it, express concern and ask how he or she is doing.

* Don’t respond with just the barebones information about what hospice is and the Medicare Hospice Benefit.

* Expect some resistance, since most people are reluctant to do end-of-life planning. Offer to make a free visit to help the family explore resources.

* Set up an initial visit before you end the conversation. Send someone out that day to talk to the family about community programs. Stress that the visit is a free community service and share that families often find it helpful when they’re first faced with deciding about hospice.

The article offers a number of tips compiled from several experts. Among them are Cheri Lyn Deary, COO of Great Lakes Home Health and Hospice and consultants Polly Rehnwall and Dina Kittel. Among the tips are:

* Role-play likely scenarios between callers and staff and plan ways for staff to handle various situations. Focus on having caregivers acknowledge the importance of the call to the caller and on getting a staff member to meet the caller the same day of the initial call.

* Offer immediate solutions. A plan of care will keep fear from setting in and will relieve some of the anxiety that both patients and family feel.

* Don’t stress pain management, but, instead, ask about the patient’s and family’s goals.

* Make sure callers understand that Medicare and insurers often cover the cost of hospice.

* For callers who are reluctant, suggest trying hospice for a few days with the offer of stopping it if the patient or family is uncomfortable.

* Train a small group of marketers first.

Since physicians are the referral source, marketers should be trained to focus on physicians. Rehnwall says that “physicians want a hassle-free referral process,” so “don’t do ‘Hospice 101.’” Hospices often ask for more data than home health agencies but should learn to get it from hospital sources rather than physicians.

Marketers should also ask physicians for their referrals, says the article. Get physicians to talk about the five most difficult patients in their practices and help them identify patients in the end stages of chronic diseases. Create automatic triggers for hospice referrals that are clear and specific and will “spare nursing home nurses from having to decide whether a patient is ready for hospice.” (Home Health Line, 3/17)

LEADERS ADDRESS NON-PROFIT HEALTHCARE TAX EXEMPT STATUS

In the “Opinions-Commentary” section of a recent Modern Healthcare, Bruce McPherson, executive director of the Alliance for Advancing Nonprofit Health Care, examines the recent legislative hearings on tax exemptions for non-profit healthcare institutions. The US House Ways and Means Committee Chairman, Bill Thomas (R-California), is concerned with whether non-profits provide sufficient financial assistance to low-income uninsured patients and believes that a “clearer, more specific, community-benefit standard” is needed.

Senate Finance Committee Chairman Chuck Grassley (R-Iowa) has said that the information that the Finance Committee has recently received from a number of not-for-profit hospitals “raises more questions than it answers.” He says that there aren’t even common definitions on items of comparison, such as charity care and community care. Grassley challenged the not-for-profit community to “come forward with its own substantive proposals for common definitions and reforms in such areas as community benefit, charitable care, charges to the uninsured, debt collection and joint ventures.”

According to the article, the board of the Alliance for Advancing Nonprofit Health Care is responding to Grassley’s challenge and “has developed a proposal that’s consistent with the overall movement toward greater public accountability and transparency on the part of not-for-profit healthcare organizations.” In this proposal, tax exempt healthcare organizations would be required to:

* Report annually, in a uniform manner, on benefits provided to the community. Definitions to be used would come from voluntary guidelines already developed by the Catholic Health Association and VHA.

* Write clear policies for providing financial assistance to needy underinsured and uninsured patients and adopt and broadly disseminate those policies. Policies should spell out the criteria the hospital uses to determine eligibility for financial assistance; discount amounts, rates or methods for computing the discount; whether bills are turned over to collection agencies, what kinds of legal actions are brought to bear on persons with unpaid bills and specify how the numbers of patients and the dollar amounts associated with financial assistance are calculated.

McPherson says that the proposal is “intended to address policymakers’ criticisms of the vagueness of the current community-benefit definition and standard, while preserving the flexibility that the individual not-for-profit hospital must have to address the specific needs of the community it serves within its unique financial circumstances.” (Modern Healthcare, 3/20)

PUBLIC POLICY AND COMMENTARY NOTES

* Washington Governor Chris Gregoire (D) signed a bill directing the Department of Health to establish a “secure, Web-based registry of living wills and other health care directives.” (AP, 3/18)

* A Star Tribune editorial criticizes the bill passed by the Minnesota House Health Policy and Finance Committee that would “require health professionals to give artificial nutrition and hydration to patients who can no longer feed or speak for themselves.” The author says that the bill will hamper loved ones from fulfilling a loved one’s wishes, tie doctors’ hands in caring for patients and is incorrect in asserting that terminally ill patients suffer when food and water is withheld. The bill “shows contempt for law, medical knowledge, family privacy and the best interests of patients.” (Star Tribune, 3/23)

* An editorial in the Tampa Tribune encourages the legislature to change the laws to allow for-profit hospices in Florida. Florida is the only state that does not allow for-profit hospices, except for one company that was grandfathered in. The author says “For-profits could help generate business by helping to educate the public about the benefits of hospice. When there is competition, there is a spillover effect. Everyone grows.” (Tampa Tribune, 3/23)

* The DEA’s war on OxyContin has, according to critics, “focused too narrowly on doctors, exacerbating the already widespread problem of untreated or undertreated pain.” A recent article says that doctors are frightened by “a brutal display of executive power” and have abandoned the patients who need the highest doses of pain medicine. Ronald Libby, a University of North Florida professor of political science, says, “Many doctors have been convicted and almost no one has been acquitted.” (Inter Press Service, 3/23)

* Several writers respond to a December article by Dr. David Casarett, et al, titled “Appropriate Use of Artificial Nutrition and Hydration – Fundamental Principles and Recommendations.” Drs. Thomas I. Cochrane and Robert D. Truog disagree with the authors over the basis for a right to refuse ANH. Dr. Darren P. Mareinns argues that the legal standard for refusal or withdrawal of ANH is necessary. Dr. Shimon M. Glick asserts that there are no studies backing up Casarett’s statement that ANH probably does not “improve the survival of patients with dementia. Casarett and his co-authors reply to each item. (NEJM, 2006;354:1320-1321)

RESEARCH AND RESOURCE NOTES

* Patients who use hypnosis as a substitute for or complement to anesthesia for surgery require less than one percent of the usual medications needed for general anesthesia. They return to work an average of 15 days after surgery, rather than the usual 28. New studies show that hypnosis prevents pain signals from reaching the brain cortex, where conscious pain feelings occur. But hypnosis will not replace anesthesia totally, since approximately 20% of people are unresponsive to it and others just choose to be “out” before the surgery even begins. (Time Magazine, 3/27)

* An article originally published in the American Journal of Critical Care gives suggestions for improving end-of-life care from critical care nurses. Most of the suggestions focus on “providing a good death.” Barriers to that aim, authors say, are “nursing time constraints, staffing patterns, communication challenges, and treatment decisions that were based on physicians' rather than patients' needs.” Suggestions for ensuring a good death include “facilitating dying with dignity; not allowing patients to be alone while dying; managing patients' pain and discomfort; knowing, and then following, patients' wishes for end-of-life care; promoting earlier cessation of treatment or not initiating aggressive treatment at all; and communicating effectively as a healthcare team.” The article is online at www.medscape.com/viewarticle/524502?src=mp. (Medscape Website; American Journal of Critical Care, 2006;15(1):38-45)

* A study from Canada examines the perceptions of seriously ill patients and their families. The items related most frequently as being “extremely important” were having trust and confidence in the doctors caring for the patient (55.8%), not being maintained on life support when no reasonable hope for recovery exists (55.7%), honest communications from doctors about the disease (44.1%), and completing things and preparing for the end of life (43.9%). The article is online at www.cmaj.ca/cgi/content/full/174/5/627. (Canadian Medical Association Journal, 2006;174(5))

OTHER NOTES

* Harvard Medical School, and others, are changing their clinical curricula to leave medical students longer in one hospital. The students are assigned to particular patients for as long as a year or more. The goal is to “better train doctors to understand illness from the patient’s perspective and appreciate how patient’s lives and the disjointed healthcare system complicate their care.” (The Boston Globe, 3/20)

* The Synergy Model for Patient Care, developed by the American Association of Critical Care Nurses, is a better way to assign nurses to patient care than by set-in-stone staffing ratios. The model calls for one nurse to continually determine the changing acuities and characteristics of patients and to assign staff with the required competencies to care for those patients. As patients’ conditions change, so does the staffing mix needed to care for them. (Chicago Hospital News, 3/2006)

* Doctors have become “choreographers of death,” says Thomas H. Murray, president of The Hastings Center. There are lots of “frayed edges” in the discussions about the morality of physicians participating in physician-assisted suicide, abortion, and the execution of convicted criminals, Murray says. He asks, “How can we expect doctors to resolve an issue our society cannot?” Murray has no illusions that “we are going to ‘solve’ death, or even reconcile within ourselves the inconsistencies that seethe within and divide our society so bitterly. Death is too wild for an easy truce. Doctors cannot disentangle themselves from our profound uneasiness with dying.” (Los Angeles Times, 3/18)

* The 4^th US Circuit Court of Appeals heard arguments in the case of pain management specialist William E. Hurwitz last week. Hurwitz is serving a 25-year sentence resulting from charges of conspiracy and drug trafficking. His lawyer told the appellate court that the trial jury “should have been told it could consider whether a doctor acted in good faith in prescribing massive doses of OxyContin and other painkillers for his patients.”(AP, 3/18)

* Merck & Company and Neuromed Pharmaceuticals have entered a collaboration to develop painkilling drugs. Merck will have the exclusive rights to Neuromed’s chronic pain drugs, which “interfere with the transmission of pain signals by blocking the influx of calcium ions into nerve cells.” NMED-160, the most advanced of those, is in mid-stage clinical trials. (The New York Times, 3/20)

Glatfelter Insurance Group is the national sponsor of Hospice News Network for 2006. Glatfelter Insurance Group provides property and liability insurance for hospices and home healthcare agencies through their Hospice and Community Care Insurance Services division. Ask your insurance agent to visit their website at www.hccis.com.