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Showing posts from July, 2015

Fifteen minutes of fame? Aging policy’s big week

Last week was a huge week in aging policy. On Monday, the White House hosted the once-a-decade Conference on Aging, an event that featured both new announcements and longtime advocates. And then on Thursday, the Senate passed the Older Americans Act Reauthorization Act by unanimous consent. It’s probably the most attention that aging issues have received in… well, in a very long time.

While advocates have a lot to cheer over the recent events, there is still much to be done. And without the bright, shiny spotlight of the White House Conference on Aging, aging advocates will be competing with the multitude of other issues facing policymakers and the upcoming presidential election. What can the aging community do? Here’s a few recommendations that come to mind.

The Older Americans Act’s reauthorization cleared one chamber—that doesn’t make it law. Advocates have been pushing for this reauthorization for years now, and it’s still not over even with the Senate’s unanimous vote. The Senat…

A strategy to improve cardiac arrest survival: Do it less on those who don't want it or won't benefit from it

On June 30, 2015, the Institute of Medicine (IOM) released a report titled "Strategies to Improve Cardiac Arrest Survival: A Time to Act”. The aim of the report was to focus on ways to improve outcomes follow a cardiac arrest, and to the reports credit, the outcome of interest was not just survival but also function. However, if there was one sentence that best summarizes my take home from this 459 page report, it would be this one from page 219:
In some ways, these cultural shifts have been built on the belief that the system should do everything possible to save every cardiac arrest patient within the jurisdiction of the system.” Just like this sentence, you can’t help feel the unbridled optimism that seems to permeate most sections of the report. Over and over again, the authors restate that cardiac arrest is a “treatable public health threat” and that if “treatments were more efficiently implemented on a broader basis” we “could avoid needless deaths and disability eac…

Secondhand Antibiotic Exposure in Nursing Homes

Antibiotics are some of the most commonly prescribed medications in nursing homes. Past studies have shown that around 2 out of 3 nursing home residents receive an antibiotic every year, mostly for urinary tract and respiration infections. While there are benefits to antibiotic use when used appropriately, there are also significant downsides to the person being prescribed these drugs: Clostridium difficile infection and diarrhea, polypharmacy, medication side effects, and the potential for future development of antibiotic-resistant organisms.

But what about those living in the nursing home who aren’t prescribed these medications, is there a risk to them even if they aren’t the ones getting the antibiotic? A recent study that came out in JAMA IM showed that not only is antibiotic use highly variable across nursing homes, but their was an association with greater harms if you happen to live in a nursing home that used a lot of antibiotics, even if you didn't get an antibio…

A Giant Thank You to CMS: Advance Care Planning Has Value

Today it is time to celebrate!

Today the Center for Medicare and Medicaid Services (CMS) announced that it is taking a tremendous step to improve the care of Medicare beneficiaries and ensure that patients receive care that matches their goals and values. CMS proposing to begin payment for advance care planning!!!

The advance care planning codes appear in the American Medical Association’s Current Procedural Terminology (CPT) manual as 99497 and 99498. These consultations are voluntary on the part of the patient and the patient’s preferences are key to the process. Look for more details about how to implement these codes soon. The CMS proposed rule for physician payment can be found here.

CMS states "For CY 2016, we are proposing to assign CPT codes 99497 and 99498 PFS status indicator "A," which is defined as: "Active code. These codes are separately payable under the PFS. There will be RVUs for codes with this status." The presence of an "A" i…

ePOLST: It's about damn time!

By: Alex Smith, @AlexSmithMD

The following is a quote from an Emergency Medicine physician I interviewed for a study about palliative care in the emergency department:
I had 2 or 3 instances that involved a very angry phone call from a primary care physician or an oncologist, who understandably had had a several month conversation with this patient, finally getting him to move to this DNR/DNI comfort measure state, and then they come in and now we have them intubated in the ICU, you know largely through miscommunication. Part of the problem involves being able to communicate effectively with people who know the patients better—their primary care providers, their oncologists— but who aren’t there at the ER at the time the patient comes in.” This is a serious problem folks. 

We spend a tremendous amount of energy working to help patients engage in advance care planning.  We have pushed the envelope on getting patients to make plans in the outpatient setting, before they are seriously …

ABIM Discontinues Requirement for Maintaining Underlying Board Certification

American Board of Internal Medicine (ABIM) has had a lot of, well, lets just say difficult press this year. There is one piece of news though that came out yesterday that should send a smile to any internal medicine physician practicing in the specialty of Hospice and Palliative Medicine and should resolve the debate that Alex Smith talked about one year ago in this GeriPal piece.  What happened? ABIM announced that it will discontinue the requirement for maintaining underlying board certification (sorry Alex, I know you already paid)!

What does all this mean?  

This means you will not have to take the re-certifying exam in Internal Medicine just so you can remain certified in Hospice and Palliative Medicine.  While there are still some good reasons to re-certify in ones primary specialty like Internal Medicine (as summed in Alex's article), there are plenty of reasons not to.  Just the cost alone is reason to celebrate as Maintenance of Certification (MOC) program fees for Intern…