This Quarter in Health Reform: Summer 2014 Roundup

Greetings, Palliative in Practice readers, and welcome to your September edition of This Quarter in Health Reform. It was a mild summer here in the northeast, perfect weather for throwing another hotdog on the grill and abandoning your commitment to take up beach volleyball.  Seasonal highlights included gubernatorial hopeful Don Berwick’s can’t-fail single payer platform, and Malia Obama’s sweet 16 party at the White House on July 4th, featuring the at once patriotic and precious rapper, Pitbull.

Of course, somewhere in there, CMS found the time to draft up about 100,000 pages of regulations, so let’s get to it, shall we?

  1. BREAKING: The Institute of Medicine, just hours ago, released the report, “Dying in America: Improving Quality and Honoring Individual Preferences at the End of Life.”  The title is lamentable, but the report makes incredibly strong recommendations regarding palliative care: that palliative care should be available to all people with serious illness in all settings, and that all health professionals should have training in basic palliative care skills, including communication and pain and symptom management. Take a few minutes to read the summary recommendations here.
  2. CMS once again ruined some sad 1st year Policy Associate’s weekend getaway plans with its whopping 2,400+ page inpatient prospective payment system final rule. This rule, which was either released on August 1 or August 22, depending on which part of the government you ask, lays out both payment system updates and quality-related updates. Shortest summary ever: readmissions penalties will go up to 3% of payments in FY 2015. Conditions tracked include heart attack, heart failure, pneumonia, chronic obstructive pulmonary disease, and hip/knee arthroplasty; and beginning in FY 2017, coronary artery bypass graft (CABG) surgical procedures.   No palliative care measures are included in the IQRS, though a 3-item care transition set was added.  CAPC continues to work with quality measurement experts to encourage the adoption of measures related to quality of life for people with serious illness.
  3. Next up, hospice policy. A lot happened this summer around hospice and if you subscribe to any of AAHPM’s or NHPCO’s mailings I’m sure you heard about it. First, drugs. This is a bit oversimplified, but in March, CMS issued guidance that required all prescribed medications for hospice patients billed to part D to be rejected for payment pending a coverage determination.  This created heartbreaking access issues for patients, and after the concerted advocacy efforts of the hospice and palliative care communities, CMS backed down from this policy in July. Now prior authorization is only required for four categories of drugs: analgesics, anti-nauseants, laxatives and anti-anxiety drugs.  CMS also ruffled feathers in its proposed Hospice wage index rule in May. The many details of this proposed rule are too lengthy to go into here, but among the issues was a proposed new definition of “terminal illness” that CMS is considering for future rulemaking.  Many stakeholders saw the proposed definition as an attempt to expand the definition of terminal illness, and thus the services that would need to be covered by the hospice per diem, and there was broad resistance to the proposal. In its final rule released in August, CMS acknowledged what it had heard from the field, but reiterated its concern about the unbundling of services under the current definition, so this issue has not been put to rest. You can see the fact sheet on the full final rule here.
  4. On a much clearer note, the Secretary has resigned! Long live the Secretary. Kathleen Sebelius, Warrior Secretary, resigned last spring, and Sylvia Burwell has been confirmed to take her place. Godspeed, Secretary Burwell; it’s only a matter of time before your visage is replaced by photographs like this.
  5. And last but not least, the Patient Quality of Life Coalition (PQLC)—a coalition formed to improve access to palliative care—had a successful lobby day this summer. Individuals from over 20 organizations had 64 meetings to promote awareness of palliative care and of two active pieces of legislation—the Patient Centered Quality Care for Life Act (link is to House bill), and the Palliative Care and Hospice Education and Training Act (again, House bill).  Its efforts resulted in 13 new cosponsors on the bills. Also worthy of note was a PQLC Twitter chat following the lobby day under the PQLC hashtag.  I’m not sure if, technically speaking, Twitter-chatting is a competition, but based on the number of tweets, I’m pretty sure I won. So step aside @ctsinclair and @rfberry, there’s a new tweet-chatter in town.

And this is a health care blog, so honorable mention has to go to—what else— the Apple watch, which marks, with its ability to determine a pulse, one of the greatest leaps forward in medical technology seen in decades. Until now, there was simply no way to know whether an individual’s heart was beating, and if it were, at what rate. This watch, which can determine a pulse at such distal and improbable locations as the wrist, ushers in a new era of symbiosis between the biological and the binary. The singularity is indeed near.

And that’s it for this quarter, folks.  Join us next week for your regularly-scheduled CAPC News Bites.  Until then, at a cool 64 bpm, signing off…

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