Resources

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.

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.

Educator Resource #1: MedEdPortal

We will be posting a series of emails/blog posts to highlight educational resources from the Education SIG throughout the year. Comments are welcome.

Dear Colleagues and Education SIG members

Now that we’ve gotten past the excitement of abstract submissions for next year’s Assembly in New Orleans, Lynn and I would like to engage you in sharing education resources with each other and our broader community. The goal is to promote increased scholarship for and dissemination of palliative care education initiatives. This email will be the first in a series to highlight a specific educator resource. All emails will also be posted on the AAHPM blog to engage a larger group of our colleagues. We encourage you to read about these resources, share your personal experiences with them, ask questions about them, pass them along to colleagues, and contribute to the conversation. Please also contact either of us directly if you would like to share a specific resource or have other ideas for pushing the shared vision of our Education SIG community forward.

Cheers, Everyone,

Laura Morrison, Chair lmorriso@bcm.edu
Lynn O’Neill, Chair-Elect lynn.oneill@duke.edu
Education Special Interest Group, AAHPM

Educator Resource #1: MedEdPortal www.mededportal.org

This major resource focuses on academic medical and dental education and is operated by the Association of American Medical Colleges (AAMC). Above all, MedEdPortal is a free, peer reviewed publication service. Because MedEdPortal publishes teaching and faculty development materials and assessment tools, it also serves as a place to find such things. In addition to medical and dental education materials, the website indicates they are now accepting interprofessional educational materials submissions that are relevant to medical or dental education. Those from non-medical disciplines can visit and submit materials.

The 3 main reasons to visit MedEdPortal:

1) Finding Education Materials and Resources for Your Program: One can easily search for curricular and assessment materials by numerous categories (medical specialty, ACGME competency, etc.) Searching under palliative care currently yields 27 items with some authors among our SIG community. You must create an account to log in and actually see the posted materials but summaries are accessible to anyone. Citations are also listed. Go see what resources you can find and avoid re-inventing the wheel.

2) Submitting Your Materials: A clear and rigorous submission and peer review process is described and diagramed on the website. This is much like a journal submission as far a formality, including a waiting period for review and feedback from editors with a decision (acceptance, rejection, and acceptance with revision). All materials accepted are published with a citation. Some institutions with clinician-educator pathways are giving these publications weight nearly equal to journal publications. Many aren’t but are still recognizing these as publications on a CV. As far as the timeline, MedEdPortal went through a major reorganization process last year to increase the efficiency of their system. It is new and improved. You should consider a submission, especially if your initiative will not be published in an article. Also, some materials published in articles are still eligible for publication here.

3) Peer Reviewing for Others: For those health professions educators interested in gaining peer review experience in this arena, MedEdPortal is accepting reviewer nominations. The website has very explicit detail about the review process and guidelines listed on the website. The listed contact is: peerreview@aamc.org

Questions:

Does anyone have experience with MedEdPortal? Have you found helpful materials or had success with a submission? Is anyone a peer reviewer?

Colleagues have indicated to me that the submission process requires attention and effort and that the review process is rigorous and highly repected. If one is successful with a publication, it’s a nice accomplishment and contribution. Comments?

I hope you’ll all consider a visit to the website www.mededportal.org and remember this terrific resource. Obviously, we need to encourage them to have a specific category for our subspecialty, and we need to grow the number of palliative care materials available in the repository.

Cheers, Laura

Common UNIPAC Questions Answered

This is the last of three posts by UNIPAC series editor Porter Storey, MD FACP FAAHPM, in which he discusses the new UNIPAC series, including the amplifire™ online confidence-based learning modules, and addresses commonly asked questions.

1. I am mainly interested in coding for hospice services, is this covered?

a. While many hospice regulations are covered, the new AAHPM Hospice Medical Director Manual is the most comprehensive resource for this material.

2. Will the 4th Edition of the UNIPAC Series help me pass the Board Exam in October?

a. While AAHPM has no inside information about the content of the ABIM sponsored exam, we used the published list of topics covered on the exam to inform the development of this edition.

b. The ABIM exam is based on the best practices and current literature in our field, which is what we surveyed and referenced extensively.

c. One of the best ways to study for any exam is to focus on those areas in which your knowledge is weakest. The accompanying amplifire confidence-based learning modules will help you identify and focus on these areas.

Porter Storey MD FACP FAAHPM
Executive VP, AAHPM
Colorado Permanente Medical Group
Boulder, CO

UNIPAC 4th edition available for purchase.

More UNIPAC Questions Answered

This is the second of three posts by UNIPAC series editor Porter Storey, MD FACP FAAHPM, in which he discusses the new UNIPAC series, including the amplifire™ online confidence-based learning modules, and addresses commonly asked questions.

At the AAHPM Annual Assembly, I was asked several good questions about the new UNIPAC Series 4th edition. Perhaps this information will help inform your purchasing decisions.

  1. Is there more information in the 4th edition than the 3rd?
    a. Older, less-relevant material was replaced with new developments, and while an effort was made to keep them succinct, some books, like the Pediatric UNIPAC grew by nearly 50%.
    b. Every effort was made to include systematic reviews and consensus statements to help the reader interpret the vast amount of new material being published in our field.
  2. Has the 4th Edition really been updated? Is it evidence-based?
    a. This edition includes 2551 references and over 600 of these are from 2010-2012.
    b. You will find material from the NHPCO Facts and Figures 2011 edition and the new American College of Physicians Ethics Manual published in 2012, among many other new sources.

Porter Storey MD FACP FAAHPM
Executive VP, AAHPM
Colorado Permanente Medical Group
Boulder, CO

UNIPAC 4th edition available for purchase.

UNIPAC 4th edition Now Available

This is the first of three posts by UNIPAC series editor Porter Storey, MD FACP FAAHPM, in which he discusses the new UNIPAC series, including the amplifire™ online confidence-based learning modules, and addresses commonly asked questions.

At the AAHPM Annual Assembly, I was asked several good questions about the new UNIPAC Series 4th edition. Perhaps this information will help inform your purchasing decisions.

1. Is the 4th Edition of the UNIPAC Series really any different that the 3rd edition?

a. Every UNIPAC was carefully revised and some (like Ethics and Pain) were completely re-written. New and extensively updated topics include:

i. the controversies around opioid contracts,
ii. the latest Catholic Ethical and Religious Directives,
iii. parental requests to withhold information from dying children,
iv. comprehensive assessment of fatigue and anorexia-cachexia,
v. management of co-infection of hepatitis C & HIV,
vi. the importance of legal decisions in the Barber, Saikewics, and Bouvia cases on withdrawing tube-feedings,
vii. treatment of agitation in dementia patients,
viii. the roles of opioids, pulmonary rehabilitation, and non-invasive ventilation in the treatment of dyspnea in patients with end-stage COPD,
ix. and many others.

b. Several of the UNIPACs have new authors who are leaders in our field (e.g. Russell Portenoy) and they were all reviewed by acknowledged experts (e.g. Timothy Quill).

Porter Storey MD FACP FAAHPM
Executive VP, AAHPM
Colorado Permanente Medical Group
Boulder, CO

UNIPAC 4th edition now available for purchase.

AAHPM Physician Compensation Survey Reveals Diversity in Pay, High Job Satisfaction

Charles V. (Chuck) Wellman, MD FAAHPM, is Chief Medical Director of Hospice of the Western Reserve in Cleveland, OH, and chair of AAHPM’s Leadership and Workforce Strategic Coordinating Committee

It is with great pleasure that we can finally announce the availability of the AAHPM Physician Compensation and Benefits Survey Report. Two years ago a poll of AAHPM’s members indicated a strong interest in such a survey. Earlier surveys, while helpful, suffered from a low rate of participation and from a lack of depth and refinement in the data. Consequently, the Academy’s Board of Directors charged the Business Practice Task Force to select a vendor who could help to design and implement such a survey. As a co-chair of the Task Force at the time and as current chair of our Leadership and Workforce Strategic Coordinating Committee, I can attest to the many hours that Task Force members spent on this process and the challenges we faced in dealing with the complexity and variability in our field.

The complexity is and will continue to be a challenge. HPM practitioners come from many different backgrounds. We work fulltime and part-time. We work for hospices, hospitals, the Veterans Administration, or as independent practitioners. Some of us are on salary while others have productivity-based compensation. We measure productivity in different ways. Some of us are in academic settings, and many of us have administrative, research, and teaching responsibilities. We have great variability in titles with no consistent agreement on chief medical officer, medical director, associate medical director, and team physician. As you might imagine, each iteration of the survey resulted in further discussion, and we realized a constant tension between designing a thorough, comprehensive survey versus a survey that might be too complex or time-consuming. In the end we find ourselves very pleased and grateful that nearly 800 of us were willing to complete this survey.

One will find that there is a wealth of data in this survey. It tells us a lot about who we are in this relatively young field. It will help to establish ranges of benefits and compensation, which will be increasingly important as we strive to attract residents and mid-career physicians to our field. The survey will give us greater flexibility in negotiating work hours, time off, productivity expectations, and CME benefits. There were also questions about job satisfaction, and it is exciting and gratifying to know 96% of us are satisfied or very satisfied with our profession and 93% of us are likely or very likely to recommend a career in HPM.

The survey will continue to be a work in progress. As we review the current survey results, it is expected that additional questions will arise, and there will be recommendations on how to further refine the survey questions. The unique and evolving arrangements in our field will challenge our future revisions, but we invite your feedback and encourage dialogue on how we can make future surveys more helpful and accurate. Comments can also be sent to the Academy at info@aahpm.org, (Subject: Comp Survey Feedback.) It is an exciting start.

NHPCO Management & Leadership Conference through Tweeter Eyes

I attended the NHPCO Conference and this year it was different. I’m a committed member of the tweeting subculture inspired by my twitter buddies after reading live commentary from sessions at the recent AAHPM conference in Canada.

I had not planned it before going to the conference but fell into it as I listened to the first session. My initial thoughts…..take notes in the form of tweets that I can review later. But with time and the growing joy in it, I embraced the mission to benefit to the bigger audience and resolved to tweet notes that others could follow, giving credit to the presenters & bringing the message to more people. I felt like a reporter bringing tales from the edge. I reveled at bringing the results of the Moran report to the twitter community, giving insight into the issues affecting the multigenerational hospice workforce, CMS’s recommendations about the Face to Face Visit regulations or bringing eAdvocacy strategies. It changed my conference experience completely. People around me asked what I was doing punching madly on my blackberry and became starry eyed at the thought of stardom in Twitterwood!

A highlight was meeting fellow tweeters. No introductions needed, we already know each other on a different level. I laugh as I approached them in hallways and at the bookstore “Hi!—– EOLnavigator. Great to finally meet you IRL (in real life). My real name —–Niamh!”

So what’s the point of tweeting live from a conference? Our collective mission is to get everybody passionate about end of life care with something to say about it online bringing their expertise to the masses and bringing the conference experience to non-attendees. I won’t miss another AAHPM conference & you can expect tweets on the road, not literally speaking! Read our tweets for the conference at www.tweetchat.com and enter #mlc11 hashtag or follow the #hpm hashtag to meet your online hospice and palliative care brothers and sisters.

JPSM Call for QI Papers Closes April 15

The Journal of Pain and Symptom Management is pleased to announce a call for papers that report the results of Quality Improvement initiatives in palliative care.

This publication of brief reports is a joint project of the American Academy of Hospice and Palliative Medicine and the National Hospice and Palliative Care Organization. Papers focusing on hospice and palliative care settings are encouraged.

The Journal offers this professional forum to encourage dialogue, peer review, and dissemination in response to a growing international concern about quality care, patient safety, and the role of evidence-based medicine. Submissions should describe specific Quality Improvement projects, such as efforts to increase pain screening, encourage goals discussions, promote palliative care consults, encourage earlier hospice referrals, or support staff well-being. Submissions must describe the impact of the intervention, either in terms of change over time or relative to a comparator.

Papers will be considered Brief Reports and must include the following:

1) A structured abstract of <150 words with five headings: Background, Measures, Intervention, Outcomes, Conclusions/Lessons Learned.

2) Five sections—Background, Measures, Intervention, Outcomes, Conclusions/Lessons learned—requiring no more than 1,250 words

3) No more than 10 references and two graphs or tables. (References/tables/ graphs are not included in the word count.)

4) A cover letter specifying that the Brief Report is being submitted in response to this Call for Papers.

Papers that fulfill the length and formatting requirements will undergo preliminary review by the Editors, and some will undergo external peer review. Acceptance for publication will depend on evaluation of the problem addressed, innovation, quality of the description, and clinical relevance of the intervention and outcomes.

Manuscripts submitted in response to this announcement should be submitted online to the Journal of Pain and Symptom Management (http://ees.elsevier.com/jps/) by April 15, 2011.

For questions regarding format or content of potential manuscripts, please contact Dr. David Casarett (Casarett@mail.med.upenn.edu).