Posts tagged Healthcare Reform

Dancing with Broken Bones: Race, Class and Spirit-Filled Dying in the Inner City (303)

David Moller has a vocation and avocation to use his training in sociology to give a voice and face to the poor, inner-city and disinfrancished living in America. There is a great divide between the large and growing underclass and the professionals that work in the medical industrial complex.

David is a voice for those people that he has spent so much time to understand, build trust and ultimately to record their suffering end experiences at the end-of-life. With his book and this presentation peole like “Angel” and “Cowboy” have achieved transcedence since capturing their stories such that their lives continue to make a difference.

If you haven’t had a chance to hear this presentation I would recommend that you listen to the recording and/or read his book of the same title. As hospcie/palliative care clinicians it is imperative that we build bridges across the care divide that exist in the USA. There is much controversy about the process of health care insurance reform. David is a voice for those Americans that have the most to lose and the most to gain as we come together to work for justice for all of us.

At the White House: ACA Implementation—An Opportunity to Advance Palliative Care

During my year as AAHPM President, I’ve had many opportunities to represent the Academy and have often been on Capitol Hill, looking to expand access to palliative care through the public policy process. On Dec. 17, the Obama administration held a meeting with community physicians at the White House to seek input about implementation of the Patient Protection and Affordable Care Act — the healthcare reform law. I was honored to be invited to attend and represent AAHPM members, as well as the other member organizations of the Hospice and Palliative Care Coalition (NHPCO, HPNA, CAPC, NPCRC and NASW).

This meeting—the first in a series—was hosted by Zeke Emanuel, MD, special adviser for health policy in the Office of Management and Budget (and brother of Obama’s former Chief of Staff Rahm) and the new CMS administrator, Don Berwick, MD, who provided a brief update on delivery system reform. The primary focus of the event, however, was to hold an open dialogue, so all participants were invited to come prepared with any questions or concerns they would like to raise. Much of the discussion focused on the launch of a new patient safety initiative and proposed rules for accountable care organizations (ACOs) participating in the Medicare program under the Affordable Care Act. I went on record stating the importance of palliative care in terms of improving quality of clinical care, improving family experience, and reducing cost. I urged inclusion of palliative care in the new ACO’s. (Read the Academy’s official comments to CMS regarding ACOs.)

There are many parts to the healthcare reform legislation, but many of the specifics are left to be defined through the rulemaking process. It will be important to see where the Academy can have the most impact by weighing in on these efforts. Last month, AAHPM joined with its Coalition partners in providing comments to the Institute of Medicine as it studies the Essential Health Benefits outlined in the Affordable Care Act. The Coalition urged officials to ensure that palliative care and hospice care are defined as essential components of all insurance plans offered under the government’s exchange, in order to deliver quality care for the nation’s sickest and most vulnerable patients. I’ll have a chance in January to speak to the IOM Committee working to define these benefits.

While I am pleased to be the voice of AAHPM’s membership, mine is not the only voice that officials want to hear. We’ve come to learn that they are looking to see not only which folks but how many folks are weighing in on these issues as a guide to how significant an issue may be. When there are opportunities for public comment that AAHPM has identified as an avenue to advance palliative care and hospice, we’ll include the details in e-News. I encourage you to follow up on these alerts. And don’t forget that you can always weigh in on legislative matters as well, directly contacting your representatives in Congress using AAHPM’s Legislative Action Center.

Healthcare Reform… Time to Act…

Healthcare Reform… TIME TO ACT!

WE (that means- you, your friends, anyone who cares about Hospic & Palliative Medicine and I) need to be involved in healthcare reform.

Doing nothing is not an option!

Questions to ponder as you peruse this Blog Entry…. (As always comments are HIGHLY encouraged…)

  1. Are you aware, many States are cutting hospice from the Medicaid budget? What’s happening in your State?
  2. Can you name the Academy’s four Advocacy Priorities? Should you care?
  3. How will the FDA/DEA/REMS affect your program’s ability to care for a dying patient?
  4. Are you ready to be an Academy Advocate?

Paul Tatum provides a fabulous summary of Diane Meier’s talk about WHY we must engage in the Healthcare reform conversation- lest be told what to do!!! Please see his blog posts for details on the “why” and “how” to get involved.

The legislative update presented by Drs. Tuch, Muir and Kollas summarized the status of healthcare reform today at the Federal and State level, the Academy’s focus for advocacy and FDA/DEA regulatory concerns specific to our field.

National Healthcare Reform Status:

  • Both the Senate and House passed Healthcare reform Bills
  • The White House is pushing for the House to pass the Senate Bill
  • Budget Reconciliation will begin with the above Bills if the House is unable to pass the Senate version
  • This will likely be a long process….

HPM and the Healthcare Reform Bills

  • Multiple provisions in each Bill and Future Bills:
    • Medicaid concurrent care provision
    • Medicare hospice concurrent care demo (Senate)
    • Hospice Payment Reform (MedPAC*, Senate)
    • National Pain Care Quality Act
    • Quality Reporting/Comparative effectiveness
    • Advance Care Planning resources (House)
    • PCTA** to be re-introduced by Senator Wyden
    • Productivity cuts affecting Medicare providers (hospice programs)

*MedPAC: Medicare Payment Advisory Commission

**PCTA: Palliative care training act

State Healthcare Concerns:

  • Many States have cut or are considering cutting Hospice Benefits from Medicaid
  • States are responsible from implementing national reform
  • Many State level initiatives to improve care-
    • POLST, Adv Dir, Sedation, IV Hydration & Nutrition
  • Continued lack of understanding of HPM

State Advocacy for HPM

Academy’s Four Focused Advocacy Areas

(Just think WARR… or come up with your own mnemonic ☺)

  • Workforce: increase the number of PC specialists
  • Access: improve patient’s ability to get PC when needed
  • Research: grants and funding focus (ex: PACA- academic achievement award)
  • Regulatory: DEA/FDA/REMS- ensure timely access to prescription medications

There are multiple sub-points under each advocacy initiative. For details on WARR :

Regulatory- DEA.FDA.REMS (see Cameron Muir’s post below)
  • DEA is concerned about diversion and abuse
  • FDA is concerned about public safety
  • REMS Risk Evaluation Mitigation Strategy­-
    • Issues addressed surrounding:
      • Access
      • Availability
      • Approval
      • Safety

For detailed information see:

Now that you have the bullet points- What is YOUR role?

Advocacy… You can do this…

  • Speak with one voice –
    • Know the Academy Focus: WARR
    • If you have special concerns- speak to Academy Advocacy Staff
      • Jackie Kosinski and Steve Smith
  • Your Representatives WANT to hear from you
    • TELL YOUR STORY! And relate the story to the Academy’s target one at a time!
    • Always bring the story back to the State level…
    • Use Resources created by the Academy
  • Get involved at the State Level!
    • This is a grassroots campaign- IF Obama did it, so can we!
    • Is your State addressing Adv Dir? POLST? Artificial nutrition and hydration? Hospice cuts?
    • Public Hearings are a great way to provide expert opinion
  • Communicate your concerns to the FDA-
    • AAHPM staff will be drafting a letter for members to send regarding regulatory concerns
  • Get involved with the Academy’s Advocacy Leaders

So… back to our questions with a few more from the audience at today’s talk:

  1. Are you aware, many States are cutting hospice from the Medicaid budget? What’s happening in your State?
  2. Can you name the Academy’s four Advocacy Priorities? Should you care?
  3. How will the FDA/DEA/REMS affect your program’s ability to care for a dying patient?
  4. Are you ready to be an Academy Advocate?
  5. Is the Academy coordinating efforts with other organizations? If so- who are they and on what?
  6. Does it really matter if the States give up Hospice Medicaid benefit?
  7. Will the DEA ever lighten up on e-prescribing?
  8. What are you doing in your State or in DC to advocate for HPM?

Let’s get the conversation started……

“How wonderful it is that nobody need wait a single moment to improve the world.”-

Anne Frank

Tanya Stewart MD FAAHPM