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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

AAHPM and Partners Receive Grant to Fund National Registries Project

Clinical data registries (CDRs) have the potential to demonstrate value and drive measure development within the specialty of hospice and palliative medicine. They also advance Maintenance of Certification and research endeavors and promote national quality improvement. The increasing requirement for quality reporting within value-based payment programs has elevated the need for organized data systems.

Physicians that submit data to a qualified CDR can satisfy some of the Center for Medicare and Medicaid Services (CMS) Merit-Based Incentive Performance System (MIPS) program requirements. With the emergence of MACRA, several organizations have expressed an interest in coming together to discuss a coordinated approach to developing or connecting CDRs for hospice and palliative medicine.

“To improve the care of patients with serious illness, we need to develop, test and implement quality measures that matter for them and provide reporting platforms that empower clinicians to engage in quality improvement,” states AAHPM Chief Medical Officer Joe Rotella, MD MBA HMDC FAAHPM. He notes that existing registries supply important pieces for solving the quality puzzle, but a complete solution will require deeper collaboration and integration.

With this goal in mind, AAHPM and its partner organizations, the Center to Advance Palliative Care (CAPC), the National Palliative Care Research Center (NPCRC), the Global Palliative Care Quality Alliance (GPCQA), and the Palliative Care Quality Network (PCQN), recently developed a proposal and were awarded a $487,000 grant from the Gordon and Betty Moore Foundation to explore the feasibility for integrating existing registries or creating a new one to advance the quality of care for patients with serious illness. AAHPM will serve as the lead organization to guide and organize this project in recognition of its mission and role as a national medical specialty society. Quality Committee chairs Christine Ritchie and Laura Hanson will serve in the Project Co-Lead roles. The activities funded by the grant will occur over a 12 month period (November 2016 – November 2017).

Over the past year, the Academy has convened groups of registry developers and other stakeholders from hospice and palliative care. “AAHPM is helping to bring key stakeholders together to identify a quality infrastructure and resources needed for hospice and palliative care clinicians and their patients,” Christian Sinclair, MD FAAHPM, Academy president adds. “This support from the Moore Foundation will help us move forward together.”

The Gordon and Betty Moore Foundation fosters path-breaking scientific discovery, environmental conservation, patient care improvements and preservation of the special character of the Bay Area. Visit Moore.org and follow @MooreFound.

Fore more information about this work and registries in general, visit our website.

Highlights of the November 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

EffenDys – Fentanyl Buccal Tablet for the Relief of Episodic Breathlessness in Patients with Advanced Cancer: A Multicenter, Open-Label, Randomized, Morphine-Controlled, Crossover, Phase II Trial

Steffen T. Simon, Marianne Kloke, Bernd Alt-Epping, Jan Gärtner, Martin Hellmich, Rebecca Hein, Maren Piel, Oliver A. Cornely, Friedemann Nauck, and Raymond Voltz

Efficacy and Safety of Two Methadone Titration Methods for the Treatment of Cancer-Related Pain: The EQUIMETH2 Trial (Methadone for Cancer-Related Pain)


Philippe Poulain, Marie-Pierre Berleur, Shimsi Lefki, Danièle Lefebvre, Gisèle Chvetzoff, Eric Serra, Fibra Tremellat, Alain Derniaux, and Marilène Filbet, for the EQUIMETH2 Study Group

Nationwide Japanese Survey About Deathbed Visions: “My Deceased Mother Took Me to Heaven”

Tatsuya Morita, Akemi Shirado Naito, Maho Aoyama, Asao Ogawa, Izuru Aizawa, Ryosuke Morooka, Masanori Kawahara, Yoshiyuki Kizawa, Yasuo Shima, Satoru Tsuneto, and Mitsunori Miyashita

Pain Assessment, Management, and Control Among Patients 65 Years or Older Receiving Hospice Care in the U.S.

Meagan Cea, M. C. Reid, Charles Inturrisi, Lisa R. Witkin, Holly G. Prigerson, and Yuhua Bao

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

Meet Our 5,000th Member!

It is with great excitement that we share that AAHPM membership has exceeded 5,000 members! This is the largest our membership has ever been and we couldn’t be where we are today without each member’s hard work and dedication to the field. To celebrate this milestone, we reached out to our 5,000th member, Kelsey Terland, MD.

Dr. Terland is currently a hospice and palliative medicine fellow at Providence Alaska Medical Center in Anchorage, AK. She isn’t native to Alaska though. She was raised in Oregon, but moved to Alaska after college. Dr. Terland attended the University of Washington School of Medicine WWAMI program which allowed her to stay in Alaska for most of her medical training. She then completed her residency at the Family Medicine Residency of Idaho in Boise.

When we asked Dr. Terland how she became interested in hospice and palliative medicine, she shared her story.

“Looking back I feel like I knew my heart was in hospice and palliative medicine even before I went to medical school”, said Terland. “Prior to medical school I worked as a case manager for patients with Alzheimer’s and related dementias. I volunteered for my local hospital’s No One Dies Alone program where I would sit with patients who were at the end of their life if they did not have family or friends to be with them. Throughout my medical training I maintained my interest in the field by participating in preceptorships with providers in the field. During my family medicine residency, I continued to find myself drawn to working with patients facing serious illness and those at the end of their lives. I spent a month during my residency working with the HPM fellowship in Anchorage and this solidified my desire to commit to the field by entering fellowship. I’m so excited for what the future may hold!”

Being a hospice and palliative medicine fellow in Alaska can be a challenge, as the state is “geographically enormous with an incredibly diverse population”, Terland says. “There are inspiring people here thinking very creatively about how to reach patients across our vast state to bring hospice and palliative medicine into very rural villages”.

Terland joined AAHPM as a way to connect with other professionals in the field and gain access to educational materials, as well as to stay up to date with the latest research.

When she isn’t dedicating her days to hospice and palliative medicine, Terland is spending time with her supportive husband and two energetic little boys, exploring the beautiful wilds of Alaska.

Kelsey Terland, MD with her two little boys

Research & Retreats: An Inside Look from AAHPM President Christian Sinclair

Each year, AAHPM awards a number of scholarships to deserving individuals to attend the Annual Kathleen M. Foley Palliative Care Retreat & Research Symposium through the Research Scholars Program. Congratulations to our 2016 recipients! Gain an insider’s view of the retreat from current AAHPM President Christian Sinclair.

_____________________

During this year as president of the American Academy of Hospice and Palliative Medicine (AAHPM), I am privileged to hear about many of the great things happening in our field. This past week I attended the Kathleen Foley Palliative Care Retreat and Research Symposium in Quebec City where junior and senior researchers gathered for education, networking and mentorship.  Dr. Sean Morrison and the National Palliative Care Research Center (NPCRC) were responsible for convening this grand meeting as they had done for the past nine years.  This year’s co-sponsors included the American Cancer Society (ACS), AAHPM, the Hospice and Palliative Nurses Association (HPNA), Gordon and Betty Moore Foundation, and Emily David and Joseph S. Kornfeld Foundation.

Like many of you, I am not a researcher, but I do consider myself quite a big fan of research, as it helps establish the foundations for our interventions and ability as a field to change systems of care. The researchers invited were a diverse group of nurses, psychologists, social workers and physicians holding grants supported by the NPCRC and ACS, research scholarships from AAHPM and HPNA, and other leaders, investors, and supporters of the field of palliative care.

During the two days of content, the approaches to learning were varied, from classic didactics from Vincent Mor, Ab Brody, Susan Mitchell and others, to the poster presentations and work-in-progress sessions from many of the junior investigators. Names that you recognize from articles like Tulsky, Arnold, Temel, Ritchie, Kutner, Teno, Ferrell, Mor, Mitchell, Wolfe and others were there to give feedback to early- and mid-career researchers as they presented their work. The camaraderie and mutual admiration was evident from the many conversations I observed and participated in.

One of the big themes at this 10th Foley Retreat, was looking to the future. The NPCRC had already accomplished many of the early goals of creating a stronger research pipeline through support of early-career scientist-clinicians, yet open discussions were held to best plan for the future in an ever-shifting funding landscape. Many felt that the support from the NPCRC and aligned organizations (like AAHPM and others) was critical to maintaining the momentum by helping palliative care researchers get started wherever they are, especially when there are only a handful of institutions able to crank out the studies we need as a young field.

Like the opportunity to visit with those preparing for the boards and hospice medical directors at this year’s Summer Institute, I am very appreciative to see the diversity of professional focus in hospice and palliative care. At the heart of these experiences is fellow hospice and palliative care clinicians supporting each other, which is one of the reasons I love this field and support the Academy.