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The National Hospice and Palliative Care Organization and it's sister organization the Hospice Action Network are hosting Hill Day in Washington DC on April 6th where they lead hospice advocates from all over the country in meeting with government representatives to talk about the role for hospice in the continuum of our nation's health care delivery system.  They bring the stories and the data to appeal to both sides of the political brain and are meeting with both major parties.

The events started today with strategy sessions to make sure the advocates were prepared with the facts and how to make the most effective use of their time.   I have never attended Hill Day but would invite anyone who is attending this year or the past to write a guest post for Pallimed to recount your experience.  Activities like this are so important as anyone who has heard Diane Meier speak recently about her experience in Washington DC.  Her discussion about optics and the view from the Hill centers around the revelation that comments and public input really do matter despite all the cynicism in the world about American politics.
But you may be thinking, 'But it is too late for me to attend Hill Day 2011, maybe I'll do that next year...'  That is a great start but I am telling you it is not enough to put this off.  You can actually act now and here are just a few ways you can help amplify the voices tomorrow for the future of hospice:

• Write your Congressional representative (using NHPCO's CapWiz system is easy)
• Donate to the Hospice Action Network (it takes staffing to make this all happen)
• Pledge with a friend or colleague at work to do some of the items in this list
• Follow @HospiceAction on Twitter and re-tweet and reply to posts with #HillDay11
• Friend Hospice Action Network on Facebook and engage/support/like their posts (Let's see if we can get them over 5,000! They are at 4,583)
• Make a meeting today with your local government representatives to make sure they know hospice matters
• Ask your company what they are doing to encourage staff to participate in advocacy
• Ask your hospice and palliative peers what you are all going to do for Hill Day 2012
• And you can watch the pep rally/kickoff for Hill Day 2011 on Ustream live at 9am ET to get in on the excitement of legislative advocacy!

And in the Pallimed spirit of asking you to do things I would do myself...

I already sent a letter to Pat Roberts and Jerry Moran (Senator from Kansas) and Kevin Yoder (Congressman from my District); Donated $30 to the Hospice Action Network; Told you about HAN; Have followed HAN on Twitter and RT a #HillDay11 post; Friended on Facebook and engaged; And pledging to you to talk to my company, local peers, and local government in the next month about hospice advocacy.  (
Total time 15 minutes.)

Now imagine if the nearly thousands of hospice and palliative care staff out there would all do any part of this.  What an impact that could be!

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Meghan O'Rourke wrote a great series of articles on grief for Slate Magazine in 2009 that will soon be part of a newly published book, The Long Goodbye.  The articles were featured on Pallimed when they first appeared and a worthy read when you get a few moments.

At the end of March, Slate published a survey asking about grief experiences.  30 questions with plenty of open ended answers.  The post already has plenty of comments which seems ripe for a dissertation or at least a letter to the editor.  Wondering what type of research this would be and why no one is publishing 'Qualitative analysis of readers comments to online article about grief.'  Regardless...I just wanted to point this out to say there are good journalistic sources out there tackling the tough issues to really subvert the notion that we are a death-denying culture.

Photo Credit: From Slate - unknown attribution

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The lead research article in the current issue of the American Journal of Physical Medicine and Rehabilitation is Inpatient Rehabilitation Improved Functional Status in Asthenic Patients with Solid and Hematologic Malignancies. It was written by a team from the Department of Palliative Care and Rehabilitation Medicine and the Department of Biostatistics at the University of Texas, MD Anderson Cancer Center. This study sought to compare functional outcomes in asthenic patients with hematologic malignancies with those of asthenic patients with solid tumors after inpatient rehabilitation.

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Hopefully many of you realized the 5 posts on April 1 were of the joking variety.

QuickMed Inc. Launches New Palliative Service: Scoops of Compassion
Reluctant Oncologist Finally Embraces Alternative Medicine
Three additional specialty boards are long shot to co-sponsor Hospice and Palliative Medicine
BREAKING NEWS: Specialty now known as Hospice, Palliative Care and Puppies
New Demonstration Project Proposed for CMS by Fringe Medical Group

Thanks to Drew, Suzana, Brian, Lyle, Holly for their contributions (in no particular order).  And a big thanks to Abe R Feaulx for his crack reporting.  We may ask him back next year.

Interestingly, I had some comment son Facebook about a dermatology doctor who is doing his palliative care fellowship, the effective use of pet therapy and more.  So maybe there is some truth in the humor.  Out of curiosity: Did any post get you going for longer than the others?  What was your realization point?

Brad Stuart at GeriPal also had fun with April 1 and they actually got someone else fired up enough to write a post on another blog to rebut the April Fool's post.

And apologies for the double mailing.  That was not part of the joke, but a technical error on my part.

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Palliative Care Grand Rounds has been on hiatus for the past few months but will be coming back strong with the best of blog posts on hospice and palliative medicine.  This is a great way to showcase all the different voices out there and hopefully to encourage more people to participate with the ongoing recognition for their efforts.

Stay tuned for the new debut this Wednesday!

If you blog and are interested in hosting please email christian@pallimed.org to sign up for an upcoming month.

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(We hope you enjoyed our April Fool's jokes this year. Look for more of our past April Fool's posts here. - Ed.)

by Abe R Feaulx, Pallimed Special Reporter

Today the Center Opposing Medical Ethics Or Normalcy offered their proposal for a new demonstration project for the Centers for Medicare and Medicaid Services.  The demonstration project (if accepted)  will be requiring all Medicare participants' primary care physicians to certify that their patients will have a prognosis of 6 months or more in order to continue to receive curative care. A representative of COME-ON, who spoke to the national press on conditions of anonymity stated these measures "sound crazy but look what we imposed on hospice and this may keep those who are really sick from screwing the system."

Primary care physicians have initially responded with outrage stating that prognostication is an inexact science and that these requirements would be onerous and unfair to patients, but these concerns have largely gone without response. The same source was quoted as stating, "We all want excellent health care for ourselves and our families, but we want to make sure that we aren't paying for all those other people. This is the next step to ensure that our tax dollars are well spent."

This requirement is being considered after a small pilot project showed an 98% reduction in costs. In the pilot, only 0.3% of beneficiaries were deemed eligible for curative care. In order to qualify for curative care, a physician must demonstrate that the patient does NOT have a chronic or terminal illness and will live for at least six months. The physician must account for potentially unforeseen events. Upon review of claim denials, the most commonly seen reasons for denial were:

• “It is not clearly demonstrated that the patient is not at risk for electrocution from a lightning strike. This remains a risk factor for death in the next six months.”
• “It is not clearly demonstrated that this patient will not be a victim of a terrorist attack. The Homeland Security Advisory System level is yellow indicating an elevated risk of terrorist attacks. This remains a risk factor for death in the next six months.” 
• "It is not clearly demonstrated that this patient will not aspirate on popcorn while watching a movie with his children. This remains a risk factor for death in the next six months."
• "It is not clearly demonstrated that this patient will not have a stroke or fatal seizure while listening to "Friday" by Rebeca Black This remains a risk factor for death in the next six months."

The pilot received mixed reviews from  beneficiaries. Farmer Willie Simpson indicated that he was pleased with services that he received for his coronary artery disease and diabetes until he required a hospitalization for chest pain. “When I arrived at the hospital, I received notification from the social worker that my claim for the hospitalization would be denied because the ambulance ride placed me at risk for a fatal motor vehicle accident. I don’t know how else I would have come into the hospital, though. My farm is 30 miles outside of town and I don't own a car.” He received a $20,000 bill in the mail the following week.

The CMS requirement that hospice providers see patients every two months to certify that those who live more than 6 months are, in fact, still dying, is still in effect.

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(We hope you enjoyed our April Fool's jokes this year. Look for more of our past April Fool's posts here. - Ed.)

by Abe R Feaulx, Pallimed Special Reporter

Due to years of trying to explain what palliative care is, how it is similar yet different from hospice and that the skill set of doctors, nurses, chaplains, social workers and other professionals extends far beyond the last few weeks of life, the organizing body Association of Palliative Realists Interested in Looking For Unified Language declared the new name for the field "Hospice, Palliative Care and Puppies."


Spokesperson and CEO for life of the Association of Palliative Realists, Frank Drebin said at an April 1st press conference, "One of the hardest things to do is get a palliative care team access to the patients that need them the most.  Members of our think tank discussed all the things that are universally loved and accepted without question to see if we could co-opt these values."  Mr. Drebin cited the hard work of Dr. Barry Rumack in coming up with the key ingredient.

"It was during a particularly difficult airplane flight, that I began to think of a few of my favorite things," shared Dr. Rumack.  "Frankly not being much of a fan of whiskers on kittens, I thought puppies would be a good fit.  Everyone loves a puppy.  Even the ugly ones like...what are they called, Pugs?  Who came up with that name? It even sounds ugly. We won't have any ugly or sad looking puppies in any of our training programs, you don't have to worry about that.  Anyway, where was I...we knew it has been so difficult to convince doctors and patients that a service focused on people would be beneficial.  Our past efforts to come up with slogans all seemed to fizzle despite the wonderful potential.  Some of my favorites were:

• "What time is it?  Who cares? The palliative care team is here and we give you all the time you need to feel heard." (that one was hard to get on posters and business cards)
  
• "Palliative care! Gesundheit!"
  
• "Do you need a pal? Call your palliative nurse!"
• "Palliative Care: Have it your way!" (Apparently, Burger King got this one trademarked one day before we did)
  
• "Hospice: so cool, it's got ice in the name!"
• "Palliators to the rescue!" (I remember we got Stan Lee to draw some comic books for this but it didn't take off.)
  
• "Palliative Medicine: So hip and fresh, they have blogs!"

Frank Drebin thinks this new name for the field will help avoid any misunderstandings.  "People like puppies, people like being heard, people like having their suffering relieved, now we can do all three."

Happy April Fools 2011 from Pallimed

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(We hope you enjoyed our April Fool's jokes this year. Look for more of our past April Fool's posts here. - Ed.)

FOR IMMEDIATE RELEASE: ABMS announces unlikely to be successful applications to co-sponsor Hospice and Palliative Medicine by additional specialties.


Chicago, TX April 1, 2011

Reported by Abe R Feaulx, Pallimed Special Reporter

At a hastily-called press conference, the ABMS Council on Curious Announcements exclaimed doubtfully that three more specialty boards have now applied to co-sponsor HPM. These applicant boards are: the American Board of Ophthalmology (ABO), the American Board of Dermatology (AMD), and the American Board of Preventive Medicine (ABPM).

Dr. Shemp Howard, a spokesperson for the council stated the applications were welcome, but did wonder aloud about what these specialties have to do with dying patients. Dr. Brian Regan, a representative of the ABO, was first to jump in with the comment that, "There are ocular manifestations of a wide spectrum of systemic diseases, including life-limiting and life-threatening disease, and everyone knows that the eyes are the windows to the soul, so we thought we should be involved."

Flint, MI physician Roger Moore, MD, the representative for ABPM, which certifies Occupational Medicine physicians, commented that "In the current economy many patients with life-limiting and life-threatening illnesses, and their family members, often have to work right up until the end. We are uniquely positioned to help and support these patients, and family members maintain their productivity in the workplace."

The representative of the ABD, Dr. Stretch Armstrong added that, while often overlooked, the skin is the largest organ, and that skin failure was under-recognized as a contributing component of the dying process, and offered that cosmiceuticals as well as laser debridement and tattoo removal could go a long way toward addressing existential distress for some seriously-ill patients. Plus, we were told that there aren't any emergencies in hospice." Spokespersons for the current HPM co-sponsoring medical boards were not present at the press conference, and none had responded to requests for comment by press time.

Happy April Fools 2011 from Pallimed

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(We hope you enjoyed our April Fool's jokes this year. Look for more of our past April Fool's posts here. - Ed.)

by Abe R Feaulx, Pallimed Special Reporter

Melinda Ungbauer, a local accountant who has been battling cancer for 5 years, is delighted that her oncologist is finally embracing complementary and alternative medicine (CAM) because it was the only way Ms. Ungabuer could get the hospice referral she has been asking for. "When he told me that she wasn't going to give me any more chemo, and was instead finally OK with a therapy I told him about called 'hot spice,' I was delighted."

Ungbauer has been trying to get her oncologist Dr. Don T Pheelgud to refer to hospice for months now.  But she finally figured that he would be ok with a treatment if she told him it was CAM since he recently supported her use of aromatherapy, acupuncture, and immune-boosting nutritional supplements for a few weeks now.  "Until recently he would only recommend more surgery and then more chemotherapy.  Hospice was out of the question as far as he was concerned.  But he was willing to give 'hot spice' a chance once I convinced him it had good evidence for quality of life in patients with treatment-refractory cancers."

Despite Dr. Don T Pheelgud eagerness for trying 'hot spice', he has been perplexed by others' lack of enthusiasm.  "I spoke to my nurse about this 'hot spice' Melinda keeps talking about.  My nurse seemed sad but she thought it was the right thing to do.  I am trying to get someone to answer me what a hot spice nurse is and what she does, but there's not even anything about it on the internet. And I know how to use Google and Yahoo!" exclaimed Dr. Don T Pheelgud.

"Apparently this 'hot spice' nurse said she'd come to Melinda's house and help her feel better, which sounds great - who wouldn't want that. But how the spice works into this no one can answer me,"

Happy April Fools 2011 from Pallimed

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(We hope you enjoyed our April Fool's jokes this year. Look for more of our past April Fool's posts here. - Ed.)

A renovated classic