DrPippa

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Posts by DrPippa

Palliative Care in the Age of Healthcare Reform: The Impact on Your Practice (403)

Diane Meier’s talk this morning was less a presentation than a call for action to the palliative care field. Dr. Meier spent a year working on capital hill and has continued to advocate for palliative care on a local and national level.

She began with a review of the Affordable Care Act and the challenges faced in our country given the current unsustainable spending on healthcare. More and more people are looking to the value equation: Value=Quality/Cost. The United States struggles to increase value and has been unable to accurately measure and increase quality, costs have continued to rise. As we debate how to cut costs it is critical that palliative care not be left out of the discussion.

Currently, most of the talk around bending the cost curve has been related to changing payment structures including the formation of Accountable Care Organizations (ACOs). High quality, well integrated palliative care is a critical piece the health care continuum, and we should be advocating that it is included in any discussion of ACOs.

Unfortunately, there are very few voices from the palliative care community “at the table” in Washington and so our concerns are often not addressed. Only a tiny portion of NIH funding (0.01%) is devoted to research in the field of palliative care which only leads to further misunderstanding of our views and mission.

So how can we make a difference? How can we make sure the palliative care is included in health care reform efforts going forward? Dr. Meier outlined several steps that we can take as a profession and as individuals.

  • Language is important. We must be consistent in how we talk about what we do. Her suggestion: “Palliative care is about matching treatment to patient goals.” What do you think?
  • Submit your organizations data to CAPC’s registry so that quality is measured and improved.
  • email/call/write a letter to your congressperson. AAHPM has made it easy!
  • Mark time off in your calendar to meet with your congressional representatives to discuss and lobby for palliative care.

Our elected officials want to hear from us and they take our views very seriously. As an movement we need to start speaking up or health care reform is going to pass us by.

New Drugs and Drug News – The 411 and implications for palliative care (334)

This session could also be known as: a whirlwind journey through 2010 pharmacology with Mary Lynn McPherson, Pharm.D., BCPS, CPE from the University of MD. She is a very entertaining and engaging speaker, also very quick! She reviewed the FDA decision to remove propoxyphene from the market, which has been highlighted in other blogs as well. She discussed the FDA concerns and restrictions regarding acetominophen in common opiod formulations. In addition, I didn’t know there was an official definition of opiod tolerance – any one of the below:

  • 60 mg oral morphine per day
  • 25 mcg TDF every three days
  • 30 mg oral oxycodone per day
  • 8 mg oral hydromorphone per day
  • 25 mg oral oxymorphone per day

Several highlights to remember:

  • Many new and very expensive drugs on the market taking advantage of alternative delivery systems
  • Nuedexta (dextromethorphan/Quinidine) for uncontrolled laughing/crying in neurological diseases. Helpful but over $600/month
  • Abstral (SL Fentanyl) available. Extensive REMS (Risk Evaluation and Mitigation Strategies – FDA) which will include special certification for providers as well as pharmacies.
  • Exalgo – a once daily hydromorphone formulation
  • BuTrans – transdermal buprenorphine which can be worn for 7 days for pain relief
  • OxyContin reformulation – designed to prevent abuse, many patients feel it isn’t as effective.
  • Duloxetine (Cymbalta) – indication for chronic musculoskeletal pain (low back pain, etc)
  • Acetaminophen IV (Ofirmev) available – long awaited by many (including me!). Will be over $10 per dose, compared to pennies for other routes of administration. Will still be huge blockbuster!
  • Cryostat – a very effective cold pack for hemorrhoid relief

Overall, LOTS of information in a great presentation. I was only sorry it was at the end of the day (I feel much sharper earlier in the day!).

Would be curious if anyone else picked up other tips that might be helpful – please share in comments.