Sunday, June 14, 2009

Palliative Care Legislation/Regulation Updates

But I'm Still Just a BillImage by cafourek via Flickr

With all this discussion about health care reform, there have been a few bills proposed lately and I am going to cover a few of them here in very little detail. I would invite anyone who knows a lot more about these to write a personal (not canned) post and Drew and I will consider it for publication here. Email me at ctsinclair a.t. gmail dot c0m. More commentary on all these bills at the end of the post.

S.B. 1150 Advance Planning and Compassionate Care Act of 2009 by Sen. John Rockefeller [D, WV], Sen. Thomas Carper [D, DE], Sen. Susan Collins [R, ME], Sen. Herbert Kohl [D, WI], Sen. Debbie Ann Stabenow [D, MI], Sen. Ron Wyden [D, OR]

Key Objective of the legislation include:
1. Workforce (physician and nurse practitioner) adequacy and loan forgiveness, National Service Corps, curricular changes, and GME dollars (cap exemption) necessary to assure access to quality palliative care for all Americans;

2. Development of provider reimbursement for conversations about goals of care, and in particular support for completion of orders for life sustaining treatment in appropriate patient populations (POLST);

3. Assuring access to concurrent curative and hospice care for children;

4. Incentives (payment, NQF quality measures compliance) for hospital and nursing home delivery of quality palliative care;

5. Establishment of a National Center on Palliative Care within the NIH as a mechanism to assure adequate attention to the evidence necessary to deliver highest quality of care; and

6. Conduct of an ongoing National Mortality Followback Survey to ensure a process of continuous improvement in the quality of care we deliver to this most vulnerable and needy of patient populations.
(via CAPC - more info here on how to support this bill - Hurry Deadline June 19th)

FDA Opioid Risk Evaluation and Mitigation Strategies Feedback (Deadline June 30th)

The FDA has an open comment period regarding future guidelines and restrictions on opioid prescribing which obviously could greatly affect palliative care and hospice practices. CAPC has put together some great talking points.

S.B.1251, the Senior Navigation and Planning Act of 2009
by Senator Mark Warner (VA)

Key objectives of the legislation include:

* Expanding Medicare's hospice benefits. A "transitional care" benefit would be available for terminally ill people expected to die within 18 months. Currently, Medicare covers hospice for people with a life expectancy of six months or less.
* Providing better education on living wills, counseling for dying patients and respite care for their families through that benefit.
* Requiring doctors, beginning in 2014, to offer certain Medicare patients, such as those with end-stage cancer, renal disease and congestive heart failure, information about advance directives and other planning tools. Doctors who failed to provide the information would not receive Medicare reimbursements.

(via Thaddeus Pope - Medical Futility Blog)

HR 2705: Advance Directives Incentive Act by Rep Jim McDermott [WA]

Details are minimal but Thaddeus Pope has this brief summary: Basically, it purports to amend the Internal Revenue Code to allow a refundable credit for advance directives. Unfortunately, it appears to likely to be be no more successful than the PSDA. First, the “qualified expenses” are limited to legal expenses. But presently, legal expenses are not a significant obstacle to the completion of advance directives. No attorney and usually not even a notary is required to complete an advance directive.

(via Thaddeus Pope at the Medical Futility Blog)

Not to mention the NHPCO lawsuit against CMS, the 2010 Wage Index issue, the NAHA and the Cap Reform. We need a simple site that tracks where all these things are. I am starting to get really confused with all these measures. Does anyone want to help organize the information coming from all of these sources regardless of which organization supports which bill? We could act as a non-partisan repository if someone else was up to it.

Also I see all these formalized efforts by NHPCO, CAPC, NAHA and others being potentially weaker because there is not a way for people to show they wrote letters to get a bandwagon like effect or a merit badge phenomenon. Could social media tools like Facebook, Twitter or blogs be a way to say "I wrote my letter...have you?" By the way I haven't written to support or oppose any of these measures so I guess I should stop writing this post and maybe do some grass roots advocacy. Feel free to post here if you have.

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