Glad I had my camera...

reflections of

Best post-Beatles Beatles song?

And by none other than "the quiet one"...

The Classical Music of our Generation?

Nearly 50 years later and still so, so good.

Here, Sir Paul is joined by a collection of high achieving buds.

Death panels?

You may recall that during the recent prolonged health reform debate, opponents of the then proposals cited the inclusion of "death panels" as Federally mandated authorities who could deny Grandpa necessary care and instead, send him off to die in a, perish the thought, hospice.  Unfortunately, a debate that focused on governmental empowerment cast an unfavorable light on hospice care.  That was most definitely unfortunate.

Yesterday's Boston Globe included a piece regarding the significant (and concerning) finding that where you live makes a material difference to where you'll die.  And despite the fact that 80% of us would prefer to die with dignity, with the ones we love, and at home... in some locations that's less likely.  According to the article:

Researchers at the Dartmouth Atlas Project in Lebanon, N.H., analyzed the records of 235,821 Medicare patients ages 65 and older who died between 2003 and 2007. Overall, the researchers found that one-third of patients spent their last days in hospitals and intensive-care units. But there was a big range. At one end was Manhattan, where 46.7 percent died in the hospital. In contrast, 7 percent of cancer patients died in the hospital in Mason City, Iowa.

While chemotherapy and other aggressive procedures can prolong life and enable some cancer patients to return home and to work, studies have shown that these treatments have little or no value for frail elderly patients and those with advanced cancer. But 6 percent of patients received chemotherapy in their last two weeks of life, and the rate was much higher — more than 10 percent — in some places, the researchers found.

Similarly, more than 18 percent of cancer patients were placed on a feeding tube or received cardiopulmonary resuscitation in their last two weeks of life in Manhattan, compared with less than 4 percent in Minneapolis.

Use of hospice care also varied a lot. In at least 50 academic medical centers, less than half of patients with a poor prognosis receive hospice services, the researchers found. And in some hospitals, patients were referred to hospice care so close to the day they died that it was unlikely to have provided much comfort.

Some of these findings are understandable.  Hospitals and the physicians who work there are driven to heal and to save lives.  In the distant past, most of us expected that we'd someday die in a hospital.  Today, we'd rather not.  In the not so distant past, referrals to hospice were greeted by patients and their families as admissions of failure and generated disbelief and denial.  Fortunately, that is changing as a growing proportion of the public has positive hospice experiences with loved ones.

To learn more about hospice care, click here or call 781-569-2888.

Beatles on iTunes today!

This is my bank account talking:

Compassion counts...

... because it's not only nice, it's also necessary.

We've all been patients.  We've all experienced, hopefully, the warmth of an empathetic caregiver.  The confidence that comes from knowing that the clinician before us is actually listening to what we're saying.  And the reassurance that comes from seeing that the information is being properly recorded somewhere so that others won't need you to repeat your entire story, word for word... five times.  Put that all together, and it's the value of compassion.  Unfortunately, most of us have experienced the exact opposite too. 

See today's boston.com piece regarding The Schwartz Center survey of patients and physicians on this topic.  Here's the link.

According to the article:

Dr. Beth Lown — a Mount Auburn Hospital internist and medical director of the survey’s sponsor, the Schwartz Center for Compassionate Healthcare — said she was encouraged that most doctors thought such factors could make a difference in whether a patient lives or dies.

“I think this is a knockout,’’ she said in an interview. Some “doctors feel that medical skills and scientific knowledge are the only things that turn into good outcomes. . . . I think all patients have always wanted emotional support, but it hasn’t always been in the doctors’ lexicon.’’

The survey found that doctors and patients agree on the importance of most but not all components of compassionate care, which include showing respect, listening attentively, giving information in a way that is understandable, involving the patient in medical decisions, and treating the patient as a person and not a disease.

As we continue (and for largely good reasons) to further specialize our health care industry, we also continue to depersonalize it as well.  With more and more pockets of capabilities emerging, the gaps between those islands can grow and widen.  Systems of care which emphasize filling those gaps and ensuring the highest levels of compassion will emerge and win in this rapidly changing industry.  Expect studies such as the one cited here to continue to punctuate this point.

Some are just born with the gift...

presence

Holiday Express Train Rides Again!

One more announcement for today.  This one fun:

It may still be a bit warm outside, but the VNA of Boston is looking forward to snow covered lawns, red noses and Holiday cheer! On Sunday, December 5th we will once again board the Holiday Train to the North Pole for the 17th Annual Holiday Express Train Ride and would like to invite you to join us for this magical journey!

Each year, more than 2,000 children, parents and grandparents from Malden, Melrose and Reading chug along on a magical train ride to the North Pole. This cherished annual community event features the much-anticipated reading of The Polar Express by elves from the North Pole, gifts and treats, and Santa himself.

If you would like to be involved with the Holiday Express Train Ride, please consider placing an ad in the Coloring Book which is distributed to each child and kept as a keepsake by parents. You could use this opportunity to advertise your business or feature a coupon or sales event. The goal of the event is to raise vital funds for our Maternal Child Health and Charitable Care Programs, which provide home and community-based care to the most vulnerable and needy children and their families in the areas of maternal child health, infant and pediatric care, early intervention for developmental delays and social work support for at risk families. Please call the Development Department at (617) 886-6460 with any questions or to learn more about how you can get involved in this wonderful annual tradition.

A new educational partnership

The VNA of Boston is partnering with Simmons College with the “Partnership for Advancing Home Care Education and Practice.” The two organizations hope to both educate and train home health professionals for the future and advance home health care practice and education – all ultimately intended to improve care for patients.

“Through this partnership we can access resources and experts at Simmons who can help us translate research into clinical practice to improve outcomes,” said Adele Pike, Director of Education at the VNA of Boston. “Our staff may also have the opportunity to collaborate in research and quality improvement projects with the school.”

Currently, staff from the VNA of Boston is working on a web-based home health care library for Simmons’ faculty and students. Simmons students can participate in the VNA of Boston’s CareLinks programs, which provide clinical placements for the students and enhances the agency’s presence in assisted living facilities and elderly housing programs throughout Boston. Pike concluded, “It’s a win for us, for Simmons, and ultimately our patients and our community.”

Innovating...

As recently reported in our Homecoming newsletter:

The VNA of Boston is committed to providing the residents of Greater Boston with efficient, quality, patient centered care. To better serve our community and some of the high risk health problems it faces, Clinical Centers of Excellence (CCEs) were established with focuses in Cardiopulmonary Disease, Diabetes, Maternal Child Health and Wound Care.

Our clinicians care for over 12,000 patients each year. Over 2,900 of those patients have cardiopulmonary issues, 2,600 struggled with diabetes, 2,582 are new mothers and more than 3,000 needed assistance with wound care.

The creation of CCEs will assist us in improving clinical outcomes by ensuring that the care we provide is based on evidence and is continually improving. In each of the next four issues of Homecoming we will go into more detail on each of the CCEs.

A sign of our times

I'd bet good money the Windows Phone isn't much to write home about, but this commercial?  Simply brilliant.  And a true commentary on life in 2010.

sometimes, the sky

Thinking of getting a car like this...

another look see

iPad and Modern Medicine

I've been touting the many endearing characteristics of the Apple iPad since it's launch earlier this year.  A few recent reports have noted that the iPad comprises over 95% of all tablet sales (can you even name another tablet on the market?) and industry analysts, Gartner, is recommending that businesses quickly deploy iPads (see article here).  According to Gartner:

The iPad is further portrayed as having "the potential to be hugely disruptive" to both the markets and business models of various enterprises. Aside from book and magazine publishers, Gartner posits everything from architectural firms and schools through to airlines and hospitals as being affected. "While there are no certainties, the iPad looks set to become a market-disrupting device, like the iPod before it," says Prentice. "Even if you think it is just a passing fad, the cost of early action is low, while the price of delay may well be extremely high."

It seems natural that iPads would find their way into the health care industry and HealthImaging.com has recently pointed out, with some caution, that the trend has started.

Launched in April, the iPad continues to make waves across the world. Technophiles, teenagers and grandmas alike love the iPad, which has been touted as the tool to mobilize business users. Apple has sold about 8 million, with many physicians among those who have been bitten by the iPad bug.

In a February survey by Epocrates, 20 percent of U.S. physicians planned to buy an iPad. A larger group, however, remained somewhat cautious; 38 percent of physicians expressed interest in the iPad, but wanted more information to solidify their purchase decision. 

... and... 

This fall, Stanford University in Palo Alto, Calif., equipped 98 incoming medical students with iPads. The main goal is to improve the student learning experience by giving them flexible access to content whether it is a virtual cadaver in the dissection lab, annotated lecture slides and videos in the classroom or journal articles for evidence-based practice in clinic.

The medical school has not yet determined the practical impacts of the project, but pioneers point to its potential. 

See the entire piece here.

The bad news keeps coming...

The final rule from CMS has been published and it's not good.  If you're following this blog, you no doubt understand that the home care industry has experienced deep cuts to Medicare reimbursement.  Despite valiant advocacy efforts, the most recent ruling contains more bad news.

This is a press release from the Visiting Nurse Associations of America:

Washington, DC – November 4, 2010 – In the final regulations on the Home Health Prospective Payment System Update for CY 2011, the Centers for Medicare and Medicaid Services (CMS) mandated cuts that exceed those legislated in the Affordable Care Act (ACA). Medicare home health provider rates will be cut across-the-board approximately 4.89 percent or $960 million in 2011 alone.

“Nonprofit home health providers simply cannot sustain this level of cuts and maintain the healthcare services that vulnerable patients rely upon,” stated Andy Carter, VNAA President and CEO. “VNAA worked hard to negotiate with Congress healthcare reform provisions designed to protect vulnerable patients from devastating cuts to Medicare home health reimbursement over the next ten years. We are disappointed that CMS has regulated additional Medicare cuts beyond the Affordable Care Act.”

VNAA is encouraged that CMS provided some flexibility on the requirements that home health and hospice patients must visit their physician or authorized practitioner in order to be certified for home health and recertified for hospice. For home health, CMS allows the visit to have taken place up to 90 days prior to the start of care instead of 30 days, as originally proposed, if the reason for the visit is related to why the patient needs home healthcare. If not, CMS will allow the visit to occur up to 30 days after the start of care instead of just 2 weeks, as issued in an earlier proposed rule. For hospice, CMS will also extend the timeframe for an in-person visit with a physician/authorized practitioner from 2 weeks to 30 days to recertify for hospice.

Many of the changes in the final regulations are designed to require providers to jump through hoops in an effort to address growing concerns about fraud and abuse in the Medicare home health benefit. Nonprofit home health agencies fully support federal action to thwart fraud and abuse but are concerned with the burdens placed on patients to meet the physician/practitioner visit requirements. It is very difficult to transport homebound patients to see their physician.

VNAA has developed concrete recommendations to reduce fraud and abuse in ways that do not incur significant burdens to reputable providers or patients. VNAA has also recommended CMS implement a temporary moratorium on new Medicare home health providers. (VNAA’s recommendations can be found at www.VNAA.org.)

“VNAA urges the federal government to exercise its power to establish a temporary moratorium on new Medicare agencies to put the brakes on fraud and abuse rather than mandate across-the-board cuts through legislation and regulation. Nonprofit home health agencies are already struggling and these additional cuts make it even harder for them to serve as a safety net in their communities,” stated Carter.

###
Contact:
Emily Swanson
Visiting Nurse Associations of America
202-384-1422
eswanson@vnaa.org

About VNAA: VNAA is a national association that supports, promotes and advocates for community-based nonprofit home health and hospice providers that care for all individuals regardless of complexity of condition or ability to pay. They provide comprehensive services for Medicare, Medicaid, uninsured, and privately insured patients. VNAA members share a mission to provide cost-effective and compassionate care to some of the nation's most vulnerable individuals, particularly the elderly and individuals with disabilities. Visit http://www.VNAA.org today.