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Highlights of the October 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
The Trial of Ascertaining Individual Preferences for Loved Ones’ Role in End-of-Life Decisions (TAILORED) Study: A Randomized Controlled Trial to Improve Surrogate Decision Making
Daniel P. Sulmasy, Mark T. Hughes, Gayane Yenokyan, Joan Kub, Peter B. Terry, Alan B. Astrow, Julie A. Johnson, Grace Ho, and Marie T. Nolan

Web-Based Tailored Psychoeducation for Breast Cancer Patients at the Onset of the Survivorship Phase: A Multicenter Randomized Controlled Trial
Jolien M. Admiraal, Annette W.G. van der Velden, Jenske I. Geerling, Johannes G.M. Burgerhof, Grietje Bouma, Annemiek M.E. Walenkamp, Elisabeth G.E. de Vries, Carolien P. Schr€oder, and Anna K.L. Reyners


One Size Does Not Fit All: Disease Profiles of Serious Illness Patients Receiving Specialty Palliative Care
Arif H. Kamal, Donald H. Taylor Jr, Benjamin Neely, Matthew Harker, Parampal Bhullar, John Morris, Lindsay Bonsignore, and Janet Bull


Opioid Prescribing Among Cancer and Non-cancer Patients: Time Trend Analysis in the Elderly Using Administrative Data
Lisa Barbera, Rinku Sutradhar, Anna Chu, Hsien Seow, Doris Howell, Craig C. Earle, Mary Ann O’Brien, Deb Dudgeon, Clare Atzema, Amna Husain, Ying Liu, and Carlo DeAngelis

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

Cambia Health Foundation Announces 10 New Sojourns Scholars to Advance Palliative Care

Elite group of physicians and nurses demonstrate strong leadership potential and commitment to expanding palliative care.

PORTLAND, Ore. (Sept. 20, 2017) – The Cambia Health Foundation has announced the acceptance of 10 new physicians and nurses into the Sojourns Scholar Leadership Program, the Foundation’s signature program to develop emerging palliative care leaders. With this new cohort, Cambia has now committed $7.2 million to cultivate 40 Sojourns Scholars from across the country who are working to advance palliative care.

The Sojourns Scholar program addresses a critical workforce development need and supports access to palliative care services. According to a 2016 report in the Journal of Palliative Medicine, “One-third of U.S. hospitals report no palliative care services of any kind, and access to palliative care in community settings (home, nursing home, assisted living) is limited for people who are not hospice-eligible. As a result, most people with serious illness are unlikely to receive the care they need throughout their course of illness.” Addressing these issues requires leadership, and by creating the Sojourns program, the Foundation has taken an active role in shaping the future.

The Sojourns Scholar Leadership Program is an initiative designed to identify, cultivate and advance the next generation of palliative care leaders. The new cohort was chosen following a rigorous selection process centered on their commitment to advancing the field of palliative care. Each scholar receives a two-year, $180,000 grant to support research, clinical, educational or policy projects. Scholars also receive one-to-one mentoring support and leadership training.

“The Cambia Health Foundation is focused on improving the consumer experience from birth through completion of life. Palliative care is inherently person-focused, and investing in future leaders ensures that people and families facing series illness are supported,” said Peggy Maguire, president and board chair, Cambia Health Foundation. “It is our hope that the seed that has been planted with these future leaders will inspire a workforce that delivers patient- and family-centered care across the entire nation.”

Listed below are the 2017 Sojourns Scholar Leadership Program Grant Recipients

  • Valerie Cotter, Nurse Practitioner, Johns Hopkins University School of Nursing: Advance care planning for primary care providers education program: Improving the quality of care for older adults with dementia
  • Andrew Epstein, Physician, Memorial Sloan Kettering Cancer Center: Integrating values-based advance care planning in a cancer center’s palliative care initiative
  • Matthew Gonzales, Physician, Providence Institute for Human Caring: Charting a course to a person-centered heath record
  • Vanessa Grubbs, Physician, University of California, San Francisco (UCSF): Integrating advance care planning into usual dialysis practice
  • Stephanie Harman, Physician, Stanford University School of Medicine: Harnessing machine learning to improve palliative care access
  • Debra Lotstein, Physician, Children’s Hospital Los Angeles/Keck School of Medicine, University of Southern California: Maximizing the use of home-based care for children with serious illness
  • Phillip Rodgers, Physician, University of Michigan: Palliative care in alternative payment models
  • Tatiana Sadak, Nurse Practitioner, University of Washington: Web-based dementia palliative care assessment and resource hub
  • Margaret (Gretchen) Schwarze, Physician, University of Wisconsin: National dissemination of a communication tool to increase access to palliative care for surgical patients
  • Jennifer Seaman, Nurse, University of Pittsburgh: Development and testing of a nurse-led intervention to ensure timely interdisciplinary family meetings in the ICU

To learn more about the individual scholars, please see the Sojourns Scholar page on the Cambia Health Foundation website.
Sojourns Scholar Leadership Program National Advisory Committee

  • Chair: Steve Pantilat, Director of Palliative Care Program, UCSF
  • Randy Curtis, Co-Director, University of Washington Palliative Care Center of Excellence
  • Patricia Davidson, Dean, the Johns Hopkins School of Nursing
  • Betty Ferrell, Director and Professor, City of Hope
  • Jean Kutner, Professor of Medicine and Associate Dean for Clinical Affairs, University of Colorado School of Medicine, Chief Medical Officer, University of Colorado Hospital

About Cambia Health Foundation

Based in Portland, Ore., Cambia Health Foundation is the corporate Foundation of Cambia Health Solutions, a total health solutions company dedicated to transforming the way people experience health care. Founded in 2007, Cambia Health Foundation awards grants in three program areas: Sojourns (Palliative Care workforce and leadership development, quality, access and awareness), Transforming Health Care and Children’s Behavioral Health. The Foundation has funded over $51 million in grants to advance patient- and family-centered care for all. Learn more at www.cambiahealthfoundation.org, and follow us on Twitter: @CambiaHealthFdn.

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 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

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

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.

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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.

A One-On-One with Extremis’ Dr. Jessica Zitter

In September 2016, Netflix released an original documentary, “Extremis”; a 24-minute account of the end of life experience in an ICU setting. The AAHPM member featured in the documentary, Jessica Zitter, MD, recounts her journey to becoming a hospice and palliative medicine physician and her idea for the documentary.

“In 2009, I realized the need for a movie addressing the state of dying in the Intensive Care Unit.  I had just seen “The Waiting Room,” a documentary which depicted the humanity and suffering of patients in the ER of Highland Hospital, the county hospital for Oakland, California.  I had just started working there a few months earlier.  I was blown away by the film’s rich visuals and gripping stories.  I wanted to bring that same lens to the issue of medical decision-making in the Intensive Care Unit. In this high-stakes environment, dying patients are often put on what I call the “End of life Conveyor Belt:” lined up for default high-technology life-prolongation, often without their consent or understanding.

It was a topic I couldn’t stop thinking about — although it hadn’t started out that way.  When I was a young attending in the ICU at University Hospital in Newark New Jersey, I was all about life-prolongation, always seeking that high-technology heroic rescue.  But an awareness was dawning that something wasn’t quite right.  I just didn’t know exactly what.  Then in 2003 the burgeoning Palliative Care movement found me, and rescued me from my growing moral distress.  By a stroke of luck, I happened to work at the University of Medicine and Dentistry of New Jersey (now called New Jersey Medical School), one of only four institutions to receive a grant from the Robert Wood Johnson Foundation to improve communication in ICUs.  These grants were part of RWJ’s larger initiative called Promoting Excellence in End of Life Care, run by our own Dr. Ira Byock. They were awarded in March 2003, and I was hired at UMDNJ in May of the same year.

I knew nothing about this grant until I was introduced to the members of the “family support team,” the precursor to what would become the Palliative Care team years later.  I saw them roaming the rooms of our ICU, clipboards in hand, asking patients questions I would never have thought to ask: did they understand what was going on, what was important to them, were they in pain?  Although I was initially resistant to the team’s remonstrations – “Why are you putting that catheter into a dying patient without telling her family she is dying?”- I quickly realized they were raising critical issues. Before I knew it, I was a convert. Under the guidance of Pat, the advance practice nurse who led the team, I began to practice more patient-centered care, and later passed my Palliative Care boards.  Over the ensuing years, I’ve become convinced that the Palliative Care toolbox is absolutely crucial to patient-centered practice in the ICU.

After seeing “The Waiting Room” I approached the director, Peter Nicks, and asked him if he would be willing to put a face on the suffering of patients in the ICU.  There were so many patients receiving non-beneficial and even harmful treatment, I told him. Pete, busy on another project, introduced me to Dan Krauss, who went on to direct “Extremis.” Dan, although an outsider to medical culture, was able to bring incredible sensitivity and insight to this very complex world.


I’m thrilled, and a little astonished, at the response to the film.  The initial Netflix trailer went viral, garnering an unprecedented 5.5 million views in the first three days. I believe that this indicates the potential for change in both the lay and medical communities. I am in the process of creating a teaching curriculum for medical professionals and trainees which will focus on some problematic areas within our current medical culture, particularly in the ICU, and begin to explore structural solutions for change. I hope soon to be able to provide this curriculum to the many medical schools and communities contacting me with interest in using the film in a teaching capacity.

I’ve been spending the last year working hard on a book about these issues, Extreme Measures.  The book will be published by Penguin-Random House on February 21, the day before the AAHPM conference in Phoenix.  My hope is that both the book and the movie will serve to support this movement and help show us all the need for change in the way we approach death and dying—both the lay public and the medical professionals who, like me, may have been blinded by their training.”

AAHPM will hold a book signing with Dr. Jessica Zitter at the Annual Assembly on Thursday, February 23 at 5:30pm in the Exhibit Hall. Copies of her book “Extreme Measures; Finding a Better Path to the End of Life” will be sold at the AAHPM Resource Center at Assembly.

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.