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 :

http://www.aahpm.org/pdf/09recommendations.pdf

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:

http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/ucm163647.htm

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
    • OpioidREMS@fda.hhs.gov
  • 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