The Faculty’s Top 5 Reasons to Attend the AAHPM Board Review Course

The Summer Institute will be featuring an Intensive Board Review Course on July 25-27 in Pittsburgh, PA. Get ready for your Hospice and Palliative Medicine board certification examination by experiencing this redesigned program which includes didactic presentations, interactive sessions and exam-style questions.

1)      You’re awesome.  Let’s face it, other fields may have some nice folks, but I’ve never meet a community like AAHPM.  Where else are you going to meet hundreds of bright, articulate, and compassionate people with well-honed listening skills?  Find friends and colleagues that you’ll enjoy seeing throughout your career.  It’s time to meet your tribe, and your tribe is exceptional.

2)      “This is only a test.”  Beyond a few hours of clicking answers, possessing deep understanding of your field and of the human experience will offer personal and professional benefits throughout your life.  Prepare for the REAL test – the test at the bedside. Mastery of hospice and palliative medicine comes with interacting with the material and challenging yourself and your colleagues.  Start your career strong!

3)      It’s not for everyone.  You know that lucky person who got to see the stadium-packing rock band in an intimate venue 20 years ago?  This is your one-time chance to spend a full day in an intimate setting, having direct interaction with palliative care experts.  While the larger annual assembly offers packed conference rooms and lots of excitement, this is something far different: an opportunity to be up close and personal.

4)      Improve your chances.  There are many joys of practicing in hospice and palliative medicine.  Sitting in a testing room is not one of them.  Do this well and do this once!

5)      Pittsburgh.  Yes, really.  This a great American city that is too-often overlooked.  Enjoy the panoramic views from the Dusquene Incline.  Join us for a Pirates game, visit the Andy Warhol Museum, or enjoy the waterfront trail loop at Three Rivers Park.  Beauty and wonder are there to be found if you only take the time to look.

The early bird rate ends Tuesday, June 28. Register now and save!

A Take on the Hospice Course – From the Presenters

The Summer Institute is featuring Hospice Practice is Changing – Take Charge! where you can learn the latest knowledge and tools to advance your practice and prepare for what’s coming. See what the presenters have to say about this upcoming course in Pittsburgh, PA, July 26-27, 2016.

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Deepen your knowledge and understanding of the Medicare hospice benefit to ensure your hospice is providing and documenting care that aligns with regulatory compliance.  This course will include a review of the basics, plus discuss regulatory changes and challenges – including relatedness, eligibility, narrative construct, and the new payment model – a worthwhile investment for all hospice medical directors, novice or seasoned!

- Ruth Thomson, DO FACOI FAAHPM HMDC, Chief Medical Officer at Hospice of Dayton, Inc.
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Learn how healthcare reform is likely to impact the hospice industry as we move to a value based reimbursement system. Identify benchmarks to monitor for your hospice organization to keep you in compliance and away from the auditors!

- Janet Bull, MD, Chief Medical Officer at Four Seasons

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Learn how to “debride” those insanely long lists of medications and make solid, evidence-based decisions about which ones are worth keeping and which medications can be “voted off the island.” We will introduce you to a 5 step process of deprescribing and discuss common classes of medications that leave us scratching our head: statins, PPI’s, anticoagulation, and medications used for dementia, COPD and diabetes. Everyone wins when the medications are directed the most benefit and least risk!

- Kathryn Walker, PharmD BCPS CPE, Senior Clinical Director of Palliative Care at MedStar Health
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Haven’t taken a day for yourself in months—or years?! Come rejuvenate, rewind, relax and revisit the core of what brought you into caring for dying patients and their families. Discover the latest research on burnout and the innovative approaches recently developed to promote resiliency in those of us working in overburdened hospice and palliative care teams. Network with physician colleagues and engage in topics from leadership opportunities to regulatory compliance. Let your mind and spirit be nurtured for a few days this summer – you’ll leave feeling confident and focused on how to grow and prosper in your role in hospice care.

- Kathleen Faulkner, MD FAAHPM, Good Shepherd Community Care

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A whirlwind tour of pain management topics ranging from bread and butter issues to more difficult situations and a few cutting edge techniques as well.

- Bruce Scott, MD FACP, HMDC, Assistance Professor of Internal Medicine, Wright State Physicians
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Learn more at www.aahpm.org/summerinstitute. Register soon. The early bird rate ends June 28.

AAHPM Provides Consultation to National Board of Medical Examiners on USMLE Step Exams

Physicians in all subspecialties care for patients with serious illnesses, terminal illnesses, and those near death. There is increasing discussion of the need for all physicians to have basic palliative care skills relevant to their own individual subspecialties, in order to optimally care for patients with serious illnesses. The foundational knowledge necessary to provide this care is laid in medical school and further developed and honed in residency and fellowship training. Passing the USMLE Step Examinations is required to become a licensed physician, and many training programs use those scores as part of their acceptance criteria to residency and fellowship.

In late 2015, AAHPM submitted a request to National Board of Medical Examiners (NBME) requesting that experts in hospice and palliative medicine be given an opportunity to assess the extent to which the United States Medical Licensing Examination (USMLE) Step examinations test essential palliative care knowledge necessary to providing basic care to patients in their care and to identify any critical gaps in test content.

Over the past several months, a small but mighty group of AAHPM members and palliative medicine subspecialists completed a comprehensive review of the USMLE Step examinations. On June 15-16, 2016, the team traveled to Philadelphia to the office of the National Board of Medical Examiners. Participants included: Bob Arnold, MD FAAHPM, Gary Buckholz, MD FAAHPM HMDC, Elise Carey, MD FAAHPM, Jeff Klick, MD, Laura Morrison, MD FAAHPM, Joe Rotella, MD FAAHPM HMDC MBA, Solomon Liao, MD FAAHPM, and Stacie Levine, MD FAAHPM.

The team made recommendations to enhance testing content to better reflect the basic palliative care skills necessary for all licensed physicians practicing medicine. In addition to the content review of test questions, the review team explored strategies currently being used to assess patient-physician communication skills in the Step 2 Clinical Skills Examination, which are essential to the practice of medicine generally and a core competency of hospice and palliative medicine. The hope is that this initial review will lead to further collaborations with NBME on strategies for assessing communication skills in a test format.

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:

Education Exchange

Toward Safer Transitions: A Curriculum to Teach and Assess Hospital-to-Hospice Handoffs

Neha J. Darrah and Nina R. O’Connor

Original Articles

Burdensome Physical and Depressive Symptoms Predict Heart Failure-Specific Health Status Over One Year

Hillary D. Lum, Evan P. Carey, Diane Fairclough, Mary E. Plomondon, Evelyn Hutt, John S. Rumsfeld, and David B. Bekelman

A Rasch Analysis of Assessments of Morning and Evening Fatigue in Oncology Patients Using the Lee Fatigue Scale

Anners Lerdal, Anders Kottorp, Caryl Gay, Bradley E. Aouizerat, Kathryn A. Lee, and Christine Miaskowski

Brief Report

Prescription and Deprescription of Medication During the Last 48 Hours of Life: Multicenter Study in 23 Acute Geriatric Wards in Flanders, Belgium

Nele J. Van Den Noortgate, Rebecca Verhofstede, Joachim Cohen, Ruth D. Piers, Luc Deliens, and Tinne Smets

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

Pittsburgh. Mighty. Beautiful.

According to Trip Advisor, there are 162 exciting things to do in Pittsburgh. We know you won’t have time to do them all since learning will be your priority at the AAHPM Summer Institute July 24-27, but we thought you may want to see what the top 10 things are:

  1. PNC Park “Best ballpark in the US.”
  2. Phipps Conservatory “Museum Bucket List.”
  3. Mount Washington “Best view of Pittsburgh.”
  4. Bicycle Heaven “Rare find – loved It!”
  5. Carnegie Museum of Natural History “Kids love the dinosaurs!”
  6. Heinz Field “Iconic and windy (always).”
  7. Duquesne Incline “A must do and get a panorama of the city.”
  8. Senator John Heinz History Center “Awesome exhibits!”
  9. The Strip “Perfect place to shop.”
  10. Consol Energy Center “State of the art hockey venue.”

Consider bringing your family or friends to enjoy this great city. Learn more at www.visitpittsburgh.com or follow @vstpgh on Twitter and Facebook.

AAHPM Represented at NQF Palliative and End-of-Life Care Meeting

The National Quality Forum (NQF) held an in-person meeting in Washington, DC, May 10-11, 2016, to re-evaluate 16 palliative & end-of-life care performance measures. Information about the measures being evaluated, the NQF process, and the NQF Standing Committee roster can be found on the NQF website.  AAHPM leaders Christine Ritchie, Paul Tatum, Gregg VandeKieft, and others were chosen to take part in the NQF Standing Committee.  AAHPM had previously submitted comments for the Standing Committee to consider, and AAHPM staff Katherine Ast, Director of Quality & Research, was on hand at the meeting to deliver additional comments:

“AAHPM and other organizations from the National Coalition of Hospice and Palliative Care are here to express our strong support for the continued endorsement of all the measures brought forward for maintenance in this project.  Please take note of the letter we submitted prior to this meeting which highlights some of the issues our field faces that contribute to our lack of relevant measures, particularly those with a true palliative care denominator. What we want to emphasize today is how critical it is that we keep the endorsement of the measures we do have so they can be used to improve the quality of care for our patients and families and to enable our clinicians to participate in value-based reimbursement.

NQF, CMS and the MAP have indicated though various publications and rule-making that palliative and end-of-life care represents a major gap in quality measurement. NQF & CMS have also called for measures to become more cross-cutting. Our field is very unique since our patients are all seriously ill and death is not always a negative outcome, and can likely be a neutral or positive outcome. We need measures that are flexible, take patient preferences into account, emphasize care coordination, family meetings, goals of care, etc. The approach to measure development for our field cannot be cookie cutter. In order to increase the usability of the measures we have and expand the settings and populations for which they can be implemented, we need to keep working with what we have.

We have so few outcome measures in our field, particularly patient-reported measures and for good reasons. However, we do have NQF #0209 which is able to capture patient self-report of pain. No, it can’t capture every patient so other measures need to be developed. But it does capture patient self-report of patients who can report. NQF staff Karen Johnson asked the question at the beginning of today’s meeting that if we had outcome measures to capture enough aspects of the quality of care for patients with serious illness, would we still need process measures? Unfortunately, we have so few outcome measures, that we couldn’t possibly dispose of our process measures to measure quality. However, we do have this outcome measure and we should keep it. We believe that risk adjustment or risk stratification is not critical for this or any other measures brought forth today, although it is currently being explored for several of the measures. The measures are used for comparison among similar providers and there is no expectation that performance will be 100%.

Benchmarking is a critical component to measuring the quality of care and without measures to report and data to aggregate, we can never get to any benchmarks in our field. There are certain processes that many believe should continue to be measured, even up to a rate of 100%. (For example, not having an ICD deactivated before an expected death most consider a “never event” and yet it still happens.) What does it mean for a measure to be topped out? With such a new field still finding its place in health care and in different settings, we think all the measures are far from being topped out, even if they approach 100% performance. In addition, many measures continue to show a clear opportunity for improvement. Once we expand the measures to be reported in multiple settings and with a true palliative care denominator, then we can start to enable benchmarking and true comparison of providers. We’ll need to keep the endorsement of all the measures presented here today in order to see that goal become a reality.”

Questions? Contact Katherine Ast at kast@aahpm.org.

First Neuro-Palliative Care Workshop in Peru

On May 13-14 2016, the Peruvian Societies of Palliative Care (Sociedad Peruana de Cuidados Paliativos, SPCP) and Neurology (Sociedad Peruana de Neurologia, SPN) held their first two-day conference and workshop on “Palliative Care and Neurology” in Lima, Peru. In a country without a palliative care training program, and where the development of palliative care is limited, 90 Peruvian neurologists, neurointensivists, geriatricians, palliative care specialists, nurses, as well as some patients from the Peruvian national neurological institute (Instituto Nacional de Ciencias Neurologicas, INCN) gathered to learn about palliative care principles and the ethical considerations and challenges of neurological illness and disability. Dr. Claire Creutzfeldt, Assistant Professor of Neurology at the University of Washington, was gave an overview of neuro-palliative care and run a VitalTalk communication workshop, providing a framework for approaching discussions regarding serious illnesses.

Invited political and healthcare leaders included: Pilar Mazzetti Soler, MD PhD, neurologist, former Peruvian Minister of Health and president of the SPN and INCN; Lilian Hidalgo, MD, vice president of the SPCP; Maria Chumbe MD, neurointensivist at the INCN; and Claire Creutzfeldt, MD. These leaders participated in a roundtable discussion entitled “Visions for Neuropalliative Care in Peru” – fielding questions and debating the next steps to facilitate the growth of palliative care. Specific aspirational goals emerging from the conference included: (1) incorporation of palliative care specialists into clinical neurology ward teams; (2) development of home health and hospice programs; and (3) integration of a palliative care curriculum for medical school and residency programs.

The conference was co-organized by NIH Fogarty Global Health Scholar Anastasia Vishnevetsky, MDc from the Perelman School of Medicine at the University of Pennsylvania, and Peruvian Geriatrician Carla Zapata del Mar, MD. The Peruvian Society of Neurology and the Peruvian Society of Palliative Care co-hosted the event. Additional support was provided by the NIH Fogarty Interdisciplinary Cerebrovascular Diseases Training Program in South America (ICTuS) Grant (5D43TW009137, awarded to Drs. Joseph Zunt, Hugo Garcia and David Tirschwell) and the NIH Fogarty Global Health Fellows Program (R25TW009345, awarded to Drs. Joseph Zunt, Chandy John, Joseph Kolars and Vivek Nerurkar).  Special thanks to Drs. Juan Luis Cam, Mario Cornejo-Olivas and Miriam Cuba for their help and support with the conference organization.

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

Effects of a Short-Term Dance Movement Therapy Program on Symptoms and Stress in Patients with Breast Cancer Undergoing Radiotherapy: A Randomized, Controlled, Single-Blind Trial
Rainbow T. H. Ho, Ted C.T. Fong, Irene K. M. Cheung, Paul S. F. Yip, and Mai-yee Luk

Living with an Older Person Dying from Cancer, Lung Disease or Dementia: Health Outcomes from a General Practice Cohort Study
Elizabeth L. Sampson, Rebecca Lodwick, Greta Rait, Bridget Candy, Joe Low, Michael King, and Irene Petersen

Physicians’ and Nurse Practitioners’ Level of Pessimism About End-of-Life Care During Training: Does it Change Over Time?
Ann C. Long, Lois Downey, Ruth A. Engelberg, Dee W. Ford, Anthony L. Back, and J. Randall Curtis

Palliative Care Education in Emergency Medicine Residency Training: A Survey of Program Directors, Associate Program Directors, and Assistant Program Directors
Chadd K. Kraus, Marna R. Greenberg, Daniel. E. Ray, and Sydney Morss Dy

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

Advancing PCHETA: We Need YOU!

By Gregg VandeKieft, MD MA FAAFP FAAHPM
Chair, AAHPM Advocacy & Awareness Strategic Coordinating Committee

This week (4/5/16), Senator Tammy Baldwin (D-WI) (shown in photo addressing Academy leaders during AAHPM’s 2015 Capitol Hill Days) reintroduced the Palliative Care and Hospice Education and Training Act (PCHETA) in the U.S. Senate as S. 2748. The bill is already pending in the U.S. House (H.R. 3119) where it enjoys the support of 99 bipartisan cosponsors. Having served as co-chair of AAHPM’s Public Policy Committee the last two years, and as a regular member of the committee prior to that, it has been gratifying to see the advancement of this legislation that the Academy worked so long to develop.

PCHETA will help address the current palliative care workforce shortage by expanding opportunities for interdisciplinary education and training in the field, including establishing education centers and career incentive awards for physicians, nurses, physician assistants, social workers and other health professionals. The bill would also implement an awareness campaign, to inform patients and health professionals about the benefits of palliative care and hospice and the services available to support patients with serious or life-threatening illness, as well as direct funding toward palliative care research to strengthen clinical practice and health care delivery. (Access a bill summary.)

As a physician specializing in hospice and palliative medicine, I am excited about PCHETA’a potential to substantially impact the care of patients and families facing serious illness. At the same time, I’ve learned through my involvement in grassroots advocacy that the process requires focus and perserverence. An earlier, more limited version of the bill (the Palliative Care Training Act) was introduced back in 2004. We introduced an expanded PCHETA in Congress in 2012, and have reintroduced in each of the subsequent congressional sessions. This Congress, the bill was further expanded. AAHPM worked with other stakeholders to add new provisions related to nurse workforce training, palliative care awareness, and research funding.

We look to build support year by year… it’s just a part of the policy process. (I think this is what the German philosopher Max Weber meant when he described politics as the “strong and slow boring of hard wood.”)  Further, we know legislation like this rarely passes on its own. Bills are typically packaged together in a broader theme, so we’ll look for a vehicle to which PCHETA (or even parts of the bill) could be attached. In the meantime, it’s important to keep building momentum and to keep our eye on the goal. The introduced legislation offers us a chance to educate members of Congress about our field, our patients, and the need to expand access to palliative care and build the workforce accordingly. Reaching a certain threshold of support will allow us to push for a hearing. Getting lawmakers on board as cosponsors of PCHETA also builds visible support so, when the opportunity presents itself, there are members of Congress to push it over the finish line and know that people back home are watching.

So, today, I encourage you to take a moment to reach out to your elected officials and ask them to support PCHETA Policymakers need to understand the unique needs of patients with serious illness. Tell them your stories from the front lines of health care. Believe it or not – hearing from an “expert” constituent really does make a difference!

Here are a few ways you can be the voice for your patients and the field and help advance PCHETA:

  • E-mail your members of Congress and urge them to cosponsor PCHETA. Be sure to define and localize the benefit. An action alert with suggested talking points is available at AAHPM’s Legislative Action Center, making it easy to look up your lawmakers and send a personalized e-mail.
  • Engage in media outreach. You can write a letter to the editor (palliative care workforce needs; need for broader access to palliative care) or participate on social media (follow your member of Congress; use #PCHETA and #HPM)
  • Request time to meet with your members of Congress during the District Work Periods (they work in their district or state office about one week each month and are there many weekends) or attend a Town Hall meeting or other event in which your Member participates. Check out their websites, and sign up for their e-mail updates to learn of local events and opportunities.
  • Invite your members of Congress to visit your practice. This is a very effective way to directly show them what you do and the important impact on patient care.
  • If you already have a relationship with a federal lawmaker, or plan to be in DC and want help arranging a meeting with your members of Congress to discuss PCHETA, e-mail AAHPM’s public policy team at advocacy@aahpm.org.

Don’t forget the words of Thomas Jefferson, “We in America do not have a government by the majority. We have a government by the majority who participate.”

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:

Special Series on Measuring What Matters

Concordance of Advance Care Plans with Inpatient Directives in the Electronic Medical Record for Older Patients Admitted from the Emergency Department
Corita R. Grudzen, Philip Buonocore, Jonathan Steinberg, Joanna M. Ortiz, Lynne D. Richardson, and the AAHPM Research Committee Writing Group

Original Articles

Prevalence and Predictors of Burnout Among Hospice and Palliative Care Clinicians in the U.S.
Arif H. Kamal, Janet H. Bull, Steven P. Wolf, Keith M. Swetz, Tait D. Shanafelt, Katherine Ast, Dio Kavalieratos, Christian T. Sinclair, amd Amy P. Abernethy

Are Hospice Admission Practices Associated with Hospice Enrollment for Older African Americans and Whites?
Kimberly S. Johnson, Richard Payne, Maragatha N. Kuchibhatla, and James A. Tulsky

Special Article

Unmet Supportive Care Needs in United States Dialysis Centers and Lack of Knowledge of Available Resources to Address Them
Stacey Culp, Dale Lupu, Cheryl Arenella, Nancy Armistead, and Alvin H. Moss

Palliative Care Rounds

Locked-In Syndrome:  Case Report and Discussion of Decisional Capacity
Samuel Maiser, Ashish Kabir, David Sabsevitz, and Wendy Peltier

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 J. Casarett, MD, MA, Senior Associate Editor, JPSM