Thursday, December 30, 2010

Out of tragedy...

This past summer, I wrote about a tragedy that took place when a local family vacationed on Martha's Vineyard... and our Hospice's efforts to help with the healing and grieving process.  See here.

We recently received a nice letter from the Executive Director of Hospice of Martha's Vineyard which spoke of the efforts of our own David Quemere.

Here's a copy of that letter... with a big thank you to David and our exceptionally compassionate caregivers at VNA Hospice Care.

Hint: If you click on the letter, you'll be able to read it in a separate (and bigger) window - depending on which browser you're using.

Planning End Game

I believe it's how we're hardwired, how we approach life.  Some of us love to live in the moment and some of us love to plan.  Some of us experience a thrill in not knowing what's around the next bend, others of us feel anxiety when the road ahead is unclear, uncertain. 

Some of us focus on only the very next chess move.  And some of us plan two or three moves ahead.

Don Schumacher, head of the National Hospice and Palliative Care Organization (NHPCO), has some common sense advice about planning two or three moves ahead...
December 28, 2011

NHPCO President and CEO Don Schumacher has an opinion article posted on that we want to share with members. The article can be found on the CNN website and is copied below.

Why end-of-life planning is smart, necessary.

By J. Donald Schumacher, Special to CNN

(CNN) -- Thinking about death can be frightening, no matter your age or medical condition. As we get older, the reality of our own mortality tends to come into clearer focus; this doesn't make talking about death or life-sustaining treatments any less frightening though.

It was fear -- stoked by certain politicians -- that led to the inaccurate and misguided "death panel" rumors that surrounded health care reform proposals last year.

Beginning January 1, Medicare will reimburse physicians who advise patients, in voluntary discussions, about their preferences for end-of-life care treatment during their annual Medicare "wellness visit." This is advance care planning, and it is a good thing for seniors, their families and health care professionals.

It's not new. In 2008, President George W. Bush signed legislation that allowed end-of-life planning to be part of a patient's "welcome to Medicare" exam. Health care reform turned the welcome visit into an annual wellness visit. And now regulations clarify that these important discussions will be covered should the Medicare beneficiary wish to take advantage of this opportunity.

Advance care planning allows a person to make his or her wishes and care preferences known before being faced with a medical crisis. Advance care planning is simply smart life-planning.

Another way to think about advance care planning is that it's like planning a trip to an unfamiliar destination. If you're like many people, once you have your destination in mind, you begin mapping the route you will take to get there. Some people consult AAA or Google Maps to help them chart their course. Other people talk to friends and family members about their experiences on their trips.

While people approach mapping their route in differing ways, few would expect to arrive at their destination safely and comfortably without having a well-thought out map in hand before hitting the road. Yet only 30% of Americans have a living will, a map detailing where they want their health care to go should they become unable to voice their wishes.

An individual's personal wishes, beliefs and values are among the most important factors when making care decisions brought about by a serious or life-limiting illness. Such wishes and preferences can be known only if they are discussed openly.

Research has shown that patient-physician discussions result in a higher quality of life for patients and their family caregivers facing the end of a life.

By having Medicare cover these voluntary consultations, beneficiaries will be able to get information that will help them make their own decisions about their care and what they would or would not want at life's end. And it's only appropriate that patients should be able to have these discussions with the very physicians who have been caring for them and that these doctors be compensated for this valuable service.

An advance care planning consultation is not about limiting or rationing care. It's not about hastening death. It's not about having choices made for the patient. It's not about saving money.

Advance care planning is about examining options, planning and communicating the choices that the individual wants -- either to limit treatments, accept all treatments or something in between. The course charted is decided by individual patients, not their doctors, and certainly not the government.

Advance care planning includes completing a living will and appointing a health care proxy.
  • A living will charts the course for your health care, letting your family and health care providers know what procedures and treatments you would want provided to you and under what conditions.
  • A health care proxy or health care power of attorney form allows you to choose someone you trust to take charge of your health care decisions in case you are unable to make those decisions yourself.
  • Advance directives, as these documents are also known, can be changed as an individual's situation or wishes change.
Based on my 35 years of experience running hospice programs and caring for people at life's end, I know firsthand that frank, open discussions with one's health care providers can relieve anxiety about a situation that we all will one day face.

It makes sense that Medicare help facilitate this important planning.

The opinions expressed in this commentary are solely those of J. Donald Schumacher.

Tuesday, December 28, 2010


If you've been following this blog, you know that the Centers for Medicare and Medicaid Services (CMS) have imposed significant new physician face-to-face documentation requirements along with the dramatic funding cuts... all set to hit on January 1st.

Well, there's some good news to report:

Thanks to the advocacy of our Federal delegation and support from our partner physicians including Board members Drs. Bob Witzburg and Juergen Bludau, last week, CMS announced that they will provide a three month transition period for enforcement of the face-to-face encounter requirements.

I want to emphasize that CMS is requiring, and VNAB will meet, the January 1, 2011 implementation date of the face-to-face encounter rule. The difference is that now we have three months to iron out the kinks in the system and to work with our physician partners to ensure that patients do not lose access to home health care services while we proceed with implementation of the rule.

Our VNAB team has done a fantastic job getting our systems and processes ready for implementation of this rule so I am confident we will move forward internally with minimal disruption on January 1.

Innovation, the key...

Though the year had a few bumpy spots (for example, "antenna-gate"), I'm wondering if any company in the history of commerce has had a better year than Apple did in 2010.  Here's a "fanboy summary" (I didn't coin that) that's floating around the internet. 

Makes you think about the role of innovation and exceeding customer expectations again and again and again...

The Post Office has nothing on us...

From an email to all employees:
"That's what team work is all about..."

So says our own Dan Pagliuca when I thanked him for driving a clinician to a home in the North End during yesterday’s snowy weather.

Because last winter was so uncharacteristically mild, I never had a chance to see firsthand one of the facets of VNAB & Affiliates’ reputation - that inclement weather doesn’t deter the staff and managers from rising to the occasion and providing care to those who most need it. Well, that changed yesterday… and I was able to witness why our organization has deservedly earned that reputation.

This email is a big thank you to everyone who successfully contended with the challenges of the recent blizzard. Over the past 24 hours, I’ve heard numerous stories of commitment and persistence for which I’m grateful. Some of those stories relate to night and weekend staff and managers working hard to make sure that “must see” patients were seen, team members withstanding rough commutes to get to the office, clinicians navigating parking bans and employees volunteering to transport our staff members to patients’ homes.

Again, thank you to all who contributed.


Sunday, December 19, 2010

Would you hike this trail?

"This walkway now serves as an aproach to Makinodromo, the famous climbing sector of El Chorro in Spain's Andalucia. And it is the hairiest path. The area of El Chorro situated in the south of Spain is renowned amongst travelers and mountain hikers for its stunning scenery and climbs, yet this is not the main attraction on offer, El Chorro is host to one of the most dangerous walkways in the world, built by workers to transport materials between the Chorro and Gaitanejo Falls."  Source here.

Had it all happened in 2010

Regardless of your religious bent, you have to admit that this is clever.

Friday, December 17, 2010

Thursday, December 16, 2010

An unbalanced delay tactic?

Health reform unconstitutional?  So says a Federal judge in Virginia.  The center of this brewing storm relates to the ability of the U.S. Government to mandate that individuals purchase health insurance coverage.

And today, attorneys from 20 states have petitioned to have the new law overturned on the grounds that it will expand the government's powers in dangerous and far reaching ways.

I'm contrasting these actions with the comments of both Democratic and Republican Congressional staffers during our visit to Washington DC a few months ago (pre-midterm elections).  The prevailing sentiment was that no matter the outcome of the elections, there would never be enough political vim and vigor to overturn the reform law.

But the issue they did not address was whether or not there might be enough legal basis to attempt to accomplish the same task.  The legal challenge has been brewing for a while, but the recent decision in Virginia and the persistence of the 20 anti-reform states lends credence to the argument that legal action (or inaction) could tie up implementation of the major provisions of the law so as to render it largely irrelevant.  I've asked a few attorney friends to comment on whether there is enough legal standing to truly impact reform law implementation.  The emerging consensus view seems to be that the legal challenges may not have a great likelihood of holding water... yet, they may force substantial delays and postponements of key milestones such that a future Congress (which could actually have the votes to reverse major reform provisions) could take up the issue.

This is reminiscent of the onetime Massachusetts health reform deal crafted during the Dukakis Administration but then carved thin by the effects of time and ensuing economic crises which pushed it so far toward the back burner that it fell off the stove.

The home health industry does not have the luxury of waiting to see how these legal and political theatrics resolve.  Massive Medicare reimbursement cuts are upon us now.  Draconian face-to-face and documentation requirements are due to hit next month which will likely have the unintended effect of reducing access to services for the most needy among the populations we serve.  I fear that the high impact provisions on home care will hit now while many of the downstream provisions will ultimately be delayed or even dropped.

If we're going to have these delay tactics, it would be best if their impact could be fairly distributed...

Farewell, friend of hospice movement...

This from Carol of our VNA Hospice Care:
Elizabeth Edwards, long an advocate of hospice care, died on December 7. Her lengthy illness and death received extensive media coverage, and much of it referenced her passionate support for hospice. For that support, Edwards was named NHPCO’s 2009 Person of the Year.

Edwards spoke at the 2008 NHPCO Clinical Team Conference several years after her diagnosis with breast cancer. On that occasion, Edwards said, “Throughout my life, both personally and professionally, I have had the opportunity to see how people have been affected by illness and loss and the role the healthcare system may have played as they dealt with change in their lives. I also know that people can find a great deal of hope, even in the most challenging of life’s situations. Hospice and palliative care professionals support and care for people at a time when hope can be hard to find. The professionals of NHPCO know more than I will ever know about providing that care; I know more than I wish I knew about receiving it, and I am happy to share my perspective with them.”

Edwards, who at 61 still had two young children at home, continued her treatments until her physicians suggested it was time to stop. MarketWatch blogger Kristen Gerencher wrote of her, “Recent research suggests that starting palliative care early — at the time of diagnosis — can actually prolong life and not just increase its quality. That doesn’t mean you have to give up on aggressive treatments, and it sounds like Elizabeth Edwards went that route as long as she could and as long as that made sense to her. Maybe her life and death will usher in a new era of frank talk about what end-of-life care can be when people have grown-up conversations about the trade-offs of various approaches.”

Politics Daily’s Eleanor Clift, herself an ardent champion of hospice since her husband’s illness and death, said, “Their time in hospice, brief as it was, allowed the Edwards family – Elizabeth and John, and their grown daughter Cate – to re-visit old wounds along with the new ones that ended their marriage. Seeing a loved one on his or her death bed tends to focus the mind, and for Elizabeth, who was courageous and clear-eyed all along about the progress of her disease, hospice gave her and her estranged husband a chance to heal those wounds, forgive each other, and sort out what they want for their children, Emma Claire and Jack, who are very young.” (Politics Daily)

Holiday fun at our Southwest Office party... more fun coming today!

25+ Years of Service!  Congratulations Sue, Katy and Annette.

Saturday, December 11, 2010

A story about talent, a Mac and the power of Youtube...

According to my brother, Rob, film professor at Case Western University:

this guy shot the location footage for this film in a week
then spent three years on his mac
within a week after posting this on youtube, he was in hollywood fielding offers. he directed the film 'monsters,' out now

Thursday, December 9, 2010

Myths Surrounding Hospice

From VNA Hospice Care:

Due to the mystery of death and our inherent fears of the unknown, the word “hospice” has taken on negative and to some, perhaps, frightening connotations.

Myth: “Hospice hastens death”

Hospice does not hasten death nor does not it condone, participate or philosophically agree with the practices of euthanasia or physician-assisted suicide.

Hospice is the antithesis of such practices. Hospice care is about living your best quality of life until you die naturally.

Several recent studies have been done that show people who access hospice care earlier in their disease processes live longer and better lives than those who did not.

Myth: “Hospice withholds treatment”

The type of the care that someone receives while still hoping for cure changes as cure becomes less likely. People mistake this change in care as a lessening or a “withholding” of what is often called “aggressive” treatment. Hospice is just as “aggressive” about the care that is provided as any other form of health care.

Patients on hospice routinely still receive chemotherapy, radiation, dialysis, blood transfusions, intravenous or enteric nutrition, physical/occupation/speech therapies and diagnostic work-ups, for as long as this care is medically appropriate and indicated.

Myth: “Hospice is only for the hopeless”

The nature of hope changes throughout our lives. When we are young we hope for success, happiness and many other things for ourselves and for those we love.

When we become sick, we hope for cure and when cure is no longer possible, we hope our remaining days are ones of comfort, dignity and ones in which we are surrounded by those we love.

Hospice care is about hope.

Question of the Month:

My patients always worry that if they go onto hospice services and have to sign a “DNR” they will no longer be able to access the hospital and will loose their doctor.

What should I tell them?


Patients do not need to agree to be “DNR”. This is a choice they make and does not affect their ability to access hospice care or the hospice benefit in full. They can continue using the same hospital for any of their care needs, as necessary, and they will keep the same doctor they have come to know and love. Nothing changes.

Want to learn more?  Click here.

Wednesday, December 8, 2010


Press Release:
Boston, MA - On Sunday, December 5th the VNA of Boston’s 17th Annual Holiday Express Train Ride chugged along the Haverhill/Reading Commuter Rail line filled with nearly 2,100 passengers dressed in their best holiday pajamas.  The non-stop, hour and fifteen minute train ride departed from the Malden Center Commuter Rail Station and made stops picking up passengers at the Melrose Cedar Park Station and the Reading Depot Station.
Over 65 student volunteers from Malden, Melrose and Reading High Schools spent the day as Santa’s elves, enchanting the children with their magic and enthusiasm.  The children enjoyed a visit from their favorite cartoon characters that came to life especially for the ride.  Elmo, Winnie the Pooh, Tiger, Frosty the Snowman, the Cat in the Hat and Rudolph the Red Nosed Reindeer helped celebrate the much anticipated visit by Santa Claus.  After a reading of “The Polar Express” by Santa’s elves, cookies and milk were served along with a gift bag and a coloring book!  The children sang along with the holiday music, drew in their coloring books and in keeping with tradition, each child received a silver bell from Santa’s sleigh.

The VNA of Boston’s ability to care for our communities most vulnerable members is highly dependent upon the success of annual fundraising events like the Holiday Express Train Ride.  Last year, through the generosity of our supporters, our Free Care Fund allowed us to care for 500 patients without insurance or resources to pay for their care.  Additionally, our Maternal Child Health Program provided direct care and specialized support services to almost 2,400 children and their families, making it one of the largest programs of its kind in Massachusetts. 


Thursday, December 2, 2010


Yes, it's been a long time...

No, this blog isn't dead...

Thanks for your emails. Lot's happening here in the real world... but know that more posts are coming soon.



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