UNIPACs are Becoming Essential Practices in Hospice and Palliative Medicine

AAHPM’s top selling self-study series, UNIPAC, will be receiving a face lift in 2017. The UNIPAC is being rebranded and will be called Essential Practices in Hospice and Palliative Medicine, but will still be featured as the popular 9-volume set with newly updated content and practical cases.

The content of each book has also been reorganized into the following titles:

  1. Medical Care of People with Serious Illness
  2. Psychiatric, Psychological, and Spiritual Care
  3. Pain Assessment and Management
  4. Nonpain Symptom Management
  5. Communication and Teamwork
  6. Ethical and Legal Practice
  7. Pediatric Palliative Care and Hospice
  8. COPD, CHF, and Renal Disease
  9. HIV, Dementia, and Neurological Conditions

View our latest YouTube video on the new Essential Practices in Hospice and Palliative Medicine to gain further insight into the new edition.

Currently, all UNIPAC, 4th edition books are 50% off using promo code UNIPAC50 in the store. Get yours while supplies last! This deal lasts until June 30. After June 30, they will be gone for good.

Highlights of the June Issue of the Journal of Pain and Symptom Management

Listed below are a few articles from the most recent issue of the journal:

Original Articles

Barriers to Medical Compassion as a Function of Experience and Specialization: Psychiatry, Pediatrics, Internal Medicine, Surgery and General Practice

Antonio T. Fernando III and Nathan S. Consedine


United States Clergy Religious Values and Relationships to End-of-Life Discussions and Care

Michael J. Balboni, Adam Sullivan, Andrea C. Enzinger, Patrick T. Smith, Christine Mitchell, John R. Peteet, James Tulsky, Tyler VanderWeele, and Tracy A. Balboni


Factors Driving Live Discharge from Hospice: Provider Perspectives

Rachel Dolin, Laura C. Hanson, Sarah Rosenblum, Sally Stearns, Mark Holmes, and Pam Silberman

To access the articles, you must subscribe to JPSM or be a member of the American Academy of Hospice and Palliative Medicine (AAHPM). For further information on the Academy, call 847.375.4712 or visit aahpm.org.

Submitted by: David Casarett, MD MA, Senior Associate Editor, JPSM

Highlights of the May Issue of the Journal of Pain and Symptom Management

Listed below are a few articles from the most recent issue of the journal:

Original Articles

Defining Advance Care Planning for Adults: A Consensus Definition from a Multidisciplinary Delphi Panel

Rebecca L. Sudore, Hillary D. Lum, John J. You, Laura C. Hanson, Diane E. Meier, Steven Z. Pantilat, Daniel D. Matlock, Judith A. C. Rietjens, Ida J. Korfage, Christine S. Ritchie, Jean S. Kutner, Joan M. Teno, Judy Thomas, Ryan D. McMahan, and Daren K. Heyland

Tumor Talk and Child-Well-Being: Perceptions of “Good” and “Bad” News Among Parents of Children with Advanced Cancer

Angela M. Feraco, Veronica Dussel, Liliana Orellana, Tammy I. Kang, J. Russell Geyer, Abby R. Rosenberg, Chris Feudtner, and Joanne Wolfe

Decision-Making Regarding the Place of End-of-Life Cancer Care: The Burden on Bereaved Families and Related Factors

Sena Yamamoto, Harue Arao, Eiko Masutani, Miwa Aoki, Megumi Kishino, Tatsuya Morita, Yasuo Shima, Yoshiyuki Kizawa, Satoru Tsuneto, Maho Aoyama, and Mitsunori Miyashita

To access the articles, you must subscribe to JPSM or be a member of the American Academy of Hospice and Palliative Medicine (AAHPM). For further information on the Academy, call 847.375.4712 or visit aahpm.org.

Submitted by: David Casarett, MD MA, Senior Associate Editor, JPSM

Highlights of the April Issue of the Journal of Pain and Symptom Management

Listed below are a few articles from the most recent issue of the journal:

Original Articles

Measuring Advance Care Planning: Optimizing the Advance Care Planning Engagement Survey

Rebecca L. Sudore, Daren K. Heyland, Deborah E. Barnes, Michelle Howard, Konrad Fassbender, Carole A. Robinson, John Boscardin, and John J. You

Longitudinal Examination of Symptom Profiles Among Breast Cancer Survivors

Nancy E. Avis, Beverly Levine, Sarah A. Marshall, and Edward H. Ip

“Best Case/Worst Case”: Training surgeons to use a novel communication tool for high-risk acute surgical problems

Jacqueline M Kruser, Lauren J Taylor, Toby C Campbell, Amy Zelenski, Sara K Johnson, Michael J Nabozny, Nicole M Steffens, Jennifer L Tucholka, Kris L Kwekkeboom, and Margaret L Schwarze

To access the articles, you must subscribe to JPSM or be a member of the American Academy of Hospice and Palliative Medicine (AAHPM). For further information on the Academy, call 847.375.4712 or visit aahpm.org.

Submitted by: David Casarett, MD MA, Senior Associate Editor, JPSM

Highlights of the March Issue of the Journal of Pain and Symptom Management

Listed below are a few articles from the most recent issue of the journal:

Education Exchange

A Communications Bundle to Improve Satisfaction for Critically Ill Patients and Their Families: A Prospective, Cohort Pilot Study

Rana L. Awdish, Dana Buick, Maria Kokas, Hanan Berlin, Catherine Jackman, Cari Williamson, Michael P. Mendez, and Kristen Chasteen

Special Series on Measuring What Matters

Operationalizing the Measuring What Matters Spirituality Quality Metric in a Population of Hospitalized, Critically Ill Patients and Their Family Members

Rebecca A Aslakson, Josephine Kweku, Malonnie Kinnison, Sarabdeep Singh, Thomas Y. Crowe, II,  and the AAHPM Writing Group

Curbside Rounds: State-of-the-Art in Palliative Care

Integrating Supportive Care Principles into Dialysis Decision-Making: A Primer for Palliative Medicine Providers

Alvin H. Moss

Original Articles

Predictors of Complicated Grief and Depression in Bereaved Caregivers: A Nationwide Prospective Cohort Study

Mette Kjaergaard Nielsen, Mette Asbjoern Neergaard, Anders Bonde Jensen, Peter Vedsted, Flemming Bro, and Mai-Britt Guldin

Hospice Use and Pain Management in Elderly Nursing Home Residents with Cancer

Jacob N. Hunnicutt, Jennifer Tjia, and Kate L. Lapane

To access the articles, you must subscribe to JPSM or be a member of the American Academy of Hospice and Palliative Medicine (AAHPM). For further information on the Academy, call 847.375.4712 or visit aahpm.org.

Submitted by: David Casarett, MD MA, Senior Associate Editor, JPSM

Highlights of the February Issue of the Journal of Pain and Symptom Management

Listed below are a few articles from the most recent issue of the journal:

Education Exchange
Teaching the Art of Difficult Family Conversations
Rita Dadiz, Michael L. Spear, and Erin Denney-Koelsch

Original Articles
Dignity Therapy and Life Review for Palliative Care Patients: A Randomized Controlled Trial
Dean Vuksanovic, Heather J. Green, Murray Dyck, and Shirley A. Morrissey

Estimating the Global Need for Palliative Care for Children: A Cross-Sectional Analysis
Stephen R. Connor, Julia Downing, Joan Marston

The Use of Life-Sustaining Procedures in the Last Month of Life Is Associated With More Depressive Symptoms in Surviving Spouses
Katherine A. Ornstein, Melissa D. Aldridge, Melissa M. Garrido, Rebecca Gorges, Evan Bollens-Lund, Albert L. Siu, Kenneth M. Langa, and Amy S. Kelley

To access the articles, you must subscribe to JPSM or be a member of the American Academy of Hospice and Palliative Medicine (AAHPM). For further information on the Academy, call 847.375.4712 or visit aahpm.org.

Submitted by: David Casarett, MD MA, Senior Associate Editor, JPSM

Highlights of the January Issue of the Journal of Pain and Symptom Management

Listed below are a few articles from the most recent issue of the journal:

Special Series on Measuring What Matters

Concordance Between Veterans’ Self-Report and Documentation of Surrogate Decision Makers: Implications for Quality Measurement
Kimberly K. Garner, Patricia Dubbert, Shelly Lensing, Dennis H. Sullivan, and the AAHPM Research Committee Writing Group

Original Articles
Impact of Palliative Care Screening and Consultation in the ICU: A Multi-Hospital Quality Improvement Project
Robert J. Zalenski, Spencer S. Jones, Cheryl Courage, Denise R. Waselewsky, Anna S. Kostaroff, David Kaufman, Afzal Beemath, John Bronfman, James W. Castillo, Hicham Krayem, Anthony Marinelli, Bradley Milner, Maria Teresa Palleschi, Mona Tareen, Sheri Testani, Ayman Soubani, Julie Walch, Judy Wheeler, Sonali Wilborn, Hanna Granovsky, and Robert D. Welch

Impact of Radiation Therapy on Aggressive Care and Quality of Life Near Death
David Li, Holly G. Prigerson, Josephine Kang, and Paul K. Maciejewski

Caregivers’ Perspectives on the Use of Long-Term Oxygen Therapy for the Treatment of Refractory Breathlessness: A Qualitative Study
Aileen Collier, Katrina Breaden, Jane L. Phillips, Meera Agar, Caroline Litster, and David C. Currow

To access the articles, you must subscribe to JPSM or be a member of the American Academy of Hospice and Palliative Medicine (AAHPM). For further information on the Academy, call 847.375.4712 or visit aahpm.org.

Submitted by: David Casarett, MD MA, Senior Associate Editor, JPSM

Quick Take on the 2017 Medicare Physician Fee Schedule: 5 Things You Should Know

By Phillip E. Rodgers, MD FAAHPM
Co-chair, AAHPM Public Policy Committee and Quality-Payment Working Group
AAHPM Representative, American Medical Association/Specialty Society Relative Value Scale Update (RUC) Advisory Committee

On Nov. 15, the Center for Medicare and Medicaid Services (CMS) published the 2017 Medicare Physician Fee Schedule (PFS) Final Rule. (Access a CMS Fact Sheet.)  Each year, the PFS designates how  – and how much – physicians and eligible billing practitioners get paid through the Medicare Part B program, which continues to cover roughly 70% of all Medicare beneficiaries (and many, if not most, of the patients seen by palliative care teams).

In recent years, AAHPM has been collaborating with specialty society partners and meeting with CMS officials to advance new codes that value non face-to-face work and more appropriately recognize the work of coordinating care for complex patients. So we were very pleased to see that earlier this year CMS proposed to include some of these codes in the PFS and make other significant changes that could positively impact palliative care teams. (Read AAHPM’s comments on the Medicare PFS proposed rule.) Nearly all of these proposals were just finalized and will become effective Jan. 1.  While it will take a few weeks to fully digest all the details in the final rule, here are five key changes for 2017 that you should know about:

1) New Payment for Advance Care Planning Services Provided via Telehealth. For those of you providing CMS-approved telehealth services (and you know who you are), you can now use the advance care planning (ACP) codes to bill for ACP services. While currently limited to patients in rural or health professional shortage areas, telehealth may expand significantly in the future.

2) 30% Increase in Payment for ‘Prolonged Face-to-Face Services’ in the Outpatient and Home Settings. Many HPM clinicians use prolonged face-to-face services codes to describe services like extended family meetings, time-intensive symptom management, and complex medical decision making. In 2017, payment for prolonged F2F services in the outpatient or home setting only, will increase by 30 percent.

3) New Payment for ‘Prolonged Non Face-to-Face’ Services. Starting in January 2017, Medicare will start making payment for significant ‘non face-to-face’ time spent in activities like reviewing patient records or interacting with referring clinicians, families, and interdisciplinary team members in preparing for (or following up on) an E/M visit in the hospital, clinic or home setting.  This is a potential game changer. As long as code requirements are met (e.g. at least 30 minutes spent on a single day, which may or may not be the same day as the related E/M code), billing practitioners can now get paid for this valuable and previously unreimbursed time.

4) New Payment for ‘Complex’ Chronic Care Management. Starting in 2017, Medicare will now start making payment for ‘complex’ chronic care management codes (CCCM):  99487 (first 60 minutes) and 99489 (each add’l 30 minutes). These codes reimburse time spent by non-billing clinicians (RNs, LPNs, medical assistants, social workers, spiritual care providers and others) in care outside face-to-face visits. Compared to the existing chronic care management code (99490, billable just once a month), these codes describe more involved services for more complex patients.  They also pay at a significantly higher rate and can be billed as many times as necessary to reflect the time spent during a given month.

There are important details about these services (beneficiary consent, cost-sharing, etc.) which need to be considered but, for palliative care teams that are providing care coordination services to their patients, this could be a significant source of new revenue to help support the interdisciplinary team.

5) New Codes and Payment for Behavioral Health Integration and Cognitive Impairment Assessment and Management. These are two big, new additions to the PFS that describe and value the work of psychiatric collaborative care (using psychiatrists and behavioral care managers in primary care practices) and assessment of cognitive impairment and dementia (which, notably, has a requirement to address advance care planning and palliative care needs of patients with cognitive impairment). These code sets have many moving parts and are worth getting to know well, particularly if you or others in your organization provide these specific services.

More importantly, these additions signal Medicare’s willingness to work closely with the provider community to break new ground in describing and paying for patient-specific, non-procedural services and could lead the way to describing other services (like, for example, palliative care assessment and management).

Well, if you’ve made it this far, bravo!  You may also be thinking:  Why should I care about this stuff, or the Medicare PFS at all?  It seems very complicated, confusing, and difficult to keep track of in my busy clinical life.  And isn’t fee-for-service dying anyway? Valid points, but I’ll leave you with two reasons to care.

First, fee-for service payments from Medicare (and the vast majority of commercial payers who follow Medicare’s lead) remain big sources of professional fee revenue for palliative care providers.

Second, while we are clearly moving to value-based reimbursement, the architecture of the PFS will remain very pertinent. The majority of the changes coming with implementation of Medicare’s new Quality Payment Program—through the Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) pathways—are built on a fee-for-service chassis. This is intentional, and not only allows a smoother transition to new payment models but also retains what is still our best (if very imperfect) system to describe and value the work of clinicians caring for patients and families.

The 2017 Medicare PFS Final Rule makes measureable progress in this regard, and so deserves our attention. Review it with your favorite billing colleague or consultant, and see how you can take advantage of its new opportunities. In the meantime, AAHPM will both continue to work with stakeholder specialty societies to advance reimbursement for high-value, cognitive care services not currently described or paid for under the PFS as well as engage HPM thought leaders to support an Academy strategy aimed at advancing palliative care in emerging payment models.

Highlights of the December Issue of the Journal of Pain and Symptom Management

Listed below are a few articles from the most recent issue of the journal:


Education Exchange

How Islam Influences End-of-Life Care: Education for Palliative Care Clinicians

Madeline Leong, Sage Olnick, Tahara Akmal, Amanda Copenhaver, and Rab Razzak


Special Series on Measuring What Matters

Adherence to Measuring What Matters Items When Caring for Patients with Hematologic Malignancies vs. Solid Tumors

Thomas W. LeBlanc, Christine Ritchie, Fred Friedman, Janet Bull, Jean S. Kutner, Kimberly S. Johnson, Arif H Kamal, and the AAHPM Research Committee Writing Group


Original Articles

Staff Distress Improves by Treating Pain in Nursing Home Patients With Dementia: Results From a Cluster-Randomized Controlled Trial

Irene Aasmul, Bettina Sandgathe Husebo, and Elisabeth Flo
Continuous Home Care Reduces Hospice Disenrollment and Hospitalization After Hospice Enrollment

Shi-Yi Wang, Melissa D. Aldridge, Maureen Canavan, Emily Cherlin, and Elizabeth Bradley

To access the articles, you must subscribe to JPSM or be a member of the American Academy of Hospice and Palliative Medicine (AAHPM). For further information on the Academy, call 847.375.4712 or visit aahpm.org.

Submitted by: David Casarett, MD MA, Senior Associate Editor, JPSM

Reflecting on the Palliative Care Research Retreat

As I landed in Quebec for the Annual Kathleen M. Foley Palliative Care Retreat and Research Symposium, I had little idea what was in store for me at this fantastic professional networking opportunity. As a junior investigator in the field of palliative and end-of-life care research, I was certainly looking forward to this opportunity. But I did not expect the open doors it would provide for me. I came to this research retreat expecting it to be another conference, but what I got instead was an invaluable networking and learning opportunity. The phenomenal networking opportunity alone made this retreat prove to be one of the most valuable professional development activities I have undertaken so far. The opportunity to interact with both senior and junior investigators leading the charge in this field allowed me to expand my thinking and approach to my own lines of research. The knowledge and practical skills gained were merely icing on the cake!

For me, one of the most prized and valuable component of this research retreat was the opportunity to network with both senior and junior investigators in the field of palliative care research. Upon arriving, I quickly noticed when looking around the room that nearly all of the leading researchers whom I cite regularly in my own work were there! Due to the intimacy of this setting, I had the opportunity to have meaningful interactions with them throughout my time at the conference. It was truly a rare opportunity as a researcher. Equally as valuable, I was able to connect with many other fellow junior investigators in the field. We not only shared our own experiences of trying to secure funding and apply for career awards, but we were able to give one another critical and insightful feedback on projects we were undertaking as well as begin to form collaborations. Due to the structure of this conference, a lot of these opportune moments to get feedback on my own work occurred over breakfast or dinner. The casual, intimate, and warm environment really lent itself to these fantastic collaborative opportunities!

Another key enriching experience of this research retreat for me was getting to see the “state of the science” from leaders in the field. For instance, one of the plenary talks discussed the growing challenge we face as researchers in learning how to balance the need to run rigorous experiments with the need to disseminate and implement findings in an increasingly fast-paced clinical world. This talk sparked a really fruitful and rich conversation amongst research retreat attendees on the state of our field and how we balance this need for rigorous study design and dissemination and implementation efforts. As a junior investigator, I find myself consistently faced with this growing challenge of a world influenced by faced-paced technology and industry efforts and the slower process inherent in rigorous research design. Hearing my fellow colleagues wrestle with this same dilemma and propose creative solutions directly informed some of the research I am currently working on.

In terms of the knowledge gained, this research retreat offered many. First, there was the poster session which was run unlike any poster session I had ever attended. I headed downstairs expecting a typical poster session but instead was pleasantly surprised by formal presentations in cohort groups that allowed for meaningful conversations and presentations around each poster topic. I found this allowed the opportunity to not only ask the researchers questions about their research but to learn from my colleagues as they posed critical questions about the research projects, design, and conclusions. Second, the breakout group I attended was focused on how to engage in non-academic writing. The session leader focused on how to write op-eds, fiction, and non-fiction and spoke from his extensive and quite impressive experiences writing in these various outlets. It really opened my eyes to the possibilities of how to communicate the important work myself and others do in the world of palliative care research to a larger audience through these alternative avenues. Finally, the last session I attended before the closing plenary was focused on submitting a revision for a grant mechanism and responding to reviewer comments. I am actually in the midst of resubmitting an NIH grant, and this session served to outline key tactics to consider when resubmitting a grant. The two investigators who so generously shared examples of their own PCORI and NIH grant revisions helped bring light to how to respond to reviewer comments and increase your odds of funding. I found this to be a very valuable experience in the midst of my own grant resubmissions.

The most fantastic and enjoyable aspect of this entire conference that connected all of the poster sessions, breakout sessions, and trainings combined was the networking built into the research retreat. I loved that the research retreat built in the opportunity to meet with colleagues over fantastic dinners to engage one another on the key dilemmas and questions we face as palliative care researchers. Some of my most meaningful conversations around career and professional development as well as study design and measurement considerations all took place around the dinner table. The most special of these dinners was the opportunity dine with other fellow AAHPM Research Scholars. These bright future leaders of the field brought a lot of knowledge and wisdom to the table as well as their own experiences in carving out a career as a palliative care researcher. I enjoyed the opportunity to learn from them, network with them, and start new collaborative relationships with them to be one of the most rewarding experiences. Having leaders in the field at the table, such as Sean Morrison, only served to enrich these conversations and shed key wisdom on our own careers.

This research retreat served to orient me better to the world of palliative care research. Certainly, I have focused on this area of research within my own professional setting, but I have not yet had the opportunity to come together in a room full of diverse professionals including (but certainly not limited to!) oncologists, geriatricians, social workers, registered nurses, and a host of PhDs coming from a variety of backgrounds all centered on the area of palliative care research. The breadth and diversity of this group of individuals reflected the diversity of palliative care as a specialty. It was such an enriching experience that not only exposed me to the field of research but to the work that the National Palliative Care Research Center (NPCRC) and the American Academy of Hospice and Palliative Medicine (AAHPM) undertake. I had the opportunity to meet the leaders of these institutions first hand and was also able to learn about potential professional and funding opportunities. In fact, due solely to attending this conference, I was able to submit an LOI for receiving a pilot grant through the NPCRC. In short, this high level of exposure really made me more aware of the opportunities that exist to pursue this work.

In closing, this research retreat was perhaps the best way to “fast track” me into the world of palliative care research as I enter that world myself as a junior investigator. I walked away with a lot of knowledge, a better sense of the state of our field, formation of new collaborations (I’ve already started a peer writing group!), and key insights into how to get this work funded. I look forward to continuing my professional journey alongside these fantastic researchers. And I am very grateful for the opportunity to have attended as a Research Scholar for AAHPM!

Megan Shen, PhD
AAHPM Research Scholars Participant