Pub Date : 2003-05-01DOI: 10.1177/104990910302000303
Restricting access to long-acting pain medications may actually increase rather than decrease overall Medicaid costs, according to a study conducted for the US National Foundation of Women Legislators. Presenting the findings in Florida, State Representative Gayle Harrell warned, “it doesn’t make sense for us to limit access to prescription drugs that can help a patient avoid more costly medical procedures.” Data from a random sample of 680,000 Medicaid prescription drug recipients were analyzed to determine the occurrence and medical status of those patients treated with opioids. Results indicated that patients using long-acting opioid medications had already failed on at least two shortacting pain drugs and suffered from almost twice the number of ailments as patients taking short-acting opioids. The data indicates that restricting access to long-acting opioids can result in increased use of other, more expensive medical services, such as hospitalization and surgery. Interestingly, the study also found that Hispanic patients made up 49 percent of the prescribed drug population used in the sample but represented only 6 percent of those receiving longacting opioid medications. Although these patients were not compared for severity of illness, results do indicate a possible bias against prescribing longacting opioid medication to patients of Hispanic descent. Missouri State Representative Linda Bartelsmeyer called on the Florida Legislature to study just what the impact of limiting access to long-acting opioid medication would be on both patients and the state’s Medicaid budget. “We believe these issues could best be addressed by the creation of a Florida Pain Commission Advisory Board, comprised of patients, physicians, and pain management advocates,” she said. (Source: Last Acts in the News, March 31, 2003.)
{"title":"Hospice news","authors":"","doi":"10.1177/104990910302000303","DOIUrl":"https://doi.org/10.1177/104990910302000303","url":null,"abstract":"Restricting access to long-acting pain medications may actually increase rather than decrease overall Medicaid costs, according to a study conducted for the US National Foundation of Women Legislators. Presenting the findings in Florida, State Representative Gayle Harrell warned, “it doesn’t make sense for us to limit access to prescription drugs that can help a patient avoid more costly medical procedures.” Data from a random sample of 680,000 Medicaid prescription drug recipients were analyzed to determine the occurrence and medical status of those patients treated with opioids. Results indicated that patients using long-acting opioid medications had already failed on at least two shortacting pain drugs and suffered from almost twice the number of ailments as patients taking short-acting opioids. The data indicates that restricting access to long-acting opioids can result in increased use of other, more expensive medical services, such as hospitalization and surgery. Interestingly, the study also found that Hispanic patients made up 49 percent of the prescribed drug population used in the sample but represented only 6 percent of those receiving longacting opioid medications. Although these patients were not compared for severity of illness, results do indicate a possible bias against prescribing longacting opioid medication to patients of Hispanic descent. Missouri State Representative Linda Bartelsmeyer called on the Florida Legislature to study just what the impact of limiting access to long-acting opioid medication would be on both patients and the state’s Medicaid budget. “We believe these issues could best be addressed by the creation of a Florida Pain Commission Advisory Board, comprised of patients, physicians, and pain management advocates,” she said. (Source: Last Acts in the News, March 31, 2003.)","PeriodicalId":7716,"journal":{"name":"American Journal of Hospice and Palliative Medicine®","volume":"11 1","pages":"175 - 177"},"PeriodicalIF":0.0,"publicationDate":"2003-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78553009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2003-03-01DOI: 10.1177/104990910302000217
{"title":"Call for manuscripts","authors":"","doi":"10.1177/104990910302000217","DOIUrl":"https://doi.org/10.1177/104990910302000217","url":null,"abstract":"","PeriodicalId":7716,"journal":{"name":"American Journal of Hospice and Palliative Medicine®","volume":"194 1","pages":"157 - 157"},"PeriodicalIF":0.0,"publicationDate":"2003-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76780153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2003-01-01DOI: 10.1177/104990910302000102
Matt Stolick
This paper is intended to emphasize the existence of prognostic uncertainty in providing survival estimates while also providing a method for caring to those who want to authentically help dying patients. Facing one’s own mortality helps one authentically and compassionately be there for dying patients. The transforming experience of death as essential to one’s self as human being, recognizing that one is living a story with death necessarily a part, promises to overcome the tendency to deny the existential meaning of death for dying patients. This tendency manifests itself through dishonesty about medicine’s limitations in creating prognoses, and specifically survival estimates, as well as in holding only a curative and not palliative goal of treatment. This tendency will be replaced by honest and authentic compassionate actions with those in the process of dying. Representing this change is a focus on the patient as person, living a certain lifestyle, and defining himself by significant events and relationships in the past, present, and future. Death and dying become meaningful through incorporation into the story and style that is the patient. This meaning that is facilitated by caregivers and created by patients is central to achieving a “good death.”
{"title":"Dying to meet you: Facing mortality and enabling patient styles","authors":"Matt Stolick","doi":"10.1177/104990910302000102","DOIUrl":"https://doi.org/10.1177/104990910302000102","url":null,"abstract":"This paper is intended to emphasize the existence of prognostic uncertainty in providing survival estimates while also providing a method for caring to those who want to authentically help dying patients. Facing one’s own mortality helps one authentically and compassionately be there for dying patients. The transforming experience of death as essential to one’s self as human being, recognizing that one is living a story with death necessarily a part, promises to overcome the tendency to deny the existential meaning of death for dying patients. This tendency manifests itself through dishonesty about medicine’s limitations in creating prognoses, and specifically survival estimates, as well as in holding only a curative and not palliative goal of treatment. This tendency will be replaced by honest and authentic compassionate actions with those in the process of dying. Representing this change is a focus on the patient as person, living a certain lifestyle, and defining himself by significant events and relationships in the past, present, and future. Death and dying become meaningful through incorporation into the story and style that is the patient. This meaning that is facilitated by caregivers and created by patients is central to achieving a “good death.”","PeriodicalId":7716,"journal":{"name":"American Journal of Hospice and Palliative Medicine®","volume":"53 376 1","pages":"1 - 5"},"PeriodicalIF":0.0,"publicationDate":"2003-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83425144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2003-01-01DOI: 10.1177/104990910302000117
D. Roughton, J. Barelds, S. Brenton, Kirtsy Woolman, M. Annells
{"title":"2002 Cumulative Subject Index","authors":"D. Roughton, J. Barelds, S. Brenton, Kirtsy Woolman, M. Annells","doi":"10.1177/104990910302000117","DOIUrl":"https://doi.org/10.1177/104990910302000117","url":null,"abstract":"","PeriodicalId":7716,"journal":{"name":"American Journal of Hospice and Palliative Medicine®","volume":"27 1","pages":"74 - 78"},"PeriodicalIF":0.0,"publicationDate":"2003-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81238256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2003-01-01DOI: 10.1177/104990910302000103
Gerald M. Morris
Medicare-funded hospice is at a crossroad. It is estimated that in the year 2000, of the 2.4 million Americans who died, one in four used hospice. The demand for hospice services is projected to grow as the baby-boomer population continues to age and experiences the health issues that come with it. Yet evidence suggests the program is failing to fulfill its statutory purpose as a meaningful benefit to many, particularly those with noncancerous conditions. The causes for this include unwieldy eligibility criteria and the chilling effect of aggressive fraud enforcement. The unique nature and scope of hospice services available under Medicare, and their complex interrelationship with other Medicare benefits, all contribute to the errors and fraud graphically illustrated by government enforcement activities. Operation Restore Trust and similar enforcement activities may be restoring confidence that inappropriate expenditures are being wrung out of the hospice system. But at the same time, they are also creating distrust, particularly among those with noncancerous conditions, about whether they will receive the benefits for which they are eligible and to which they are entitled. In part, this is a consequence of the chilling effect (real or perceived) that aggressive enforcement is having on physicians and hospice medical directors who certify eligibility to the program. This paper reviews the Medicare hospice benefit, identifies the more significant fraud and abuse issues that hospice presents, examines the impact of Operation Restore Trust and other compliance activities on hospice, and makes final observations about the future.
{"title":"Hospice fraud and abuse: Operation Restore Trust and beyond","authors":"Gerald M. Morris","doi":"10.1177/104990910302000103","DOIUrl":"https://doi.org/10.1177/104990910302000103","url":null,"abstract":"Medicare-funded hospice is at a crossroad. It is estimated that in the year 2000, of the 2.4 million Americans who died, one in four used hospice. The demand for hospice services is projected to grow as the baby-boomer population continues to age and experiences the health issues that come with it. Yet evidence suggests the program is failing to fulfill its statutory purpose as a meaningful benefit to many, particularly those with noncancerous conditions. The causes for this include unwieldy eligibility criteria and the chilling effect of aggressive fraud enforcement. The unique nature and scope of hospice services available under Medicare, and their complex interrelationship with other Medicare benefits, all contribute to the errors and fraud graphically illustrated by government enforcement activities. Operation Restore Trust and similar enforcement activities may be restoring confidence that inappropriate expenditures are being wrung out of the hospice system. But at the same time, they are also creating distrust, particularly among those with noncancerous conditions, about whether they will receive the benefits for which they are eligible and to which they are entitled. In part, this is a consequence of the chilling effect (real or perceived) that aggressive enforcement is having on physicians and hospice medical directors who certify eligibility to the program. This paper reviews the Medicare hospice benefit, identifies the more significant fraud and abuse issues that hospice presents, examines the impact of Operation Restore Trust and other compliance activities on hospice, and makes final observations about the future.","PeriodicalId":7716,"journal":{"name":"American Journal of Hospice and Palliative Medicine®","volume":"32 1","pages":"1 - 8"},"PeriodicalIF":0.0,"publicationDate":"2003-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72698966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2003-01-01DOI: 10.1177/104990910302000101
I. Lawrie, M. Lloyd-Williams, Esther T Waterhouse
Durogesic ® (fentanyl) patches have revolutionized pain relief, but patients still require breakthrough medication. A retrospective analysis of in-patient admission notes at a 25-bed hospice over a six-month period was carried out. Details of analgesia being used on admission for both background and breakthrough pain were obtained, and the appropriateness of the breakthrough dose for those patients using transdermal fentanyl was determined. During the study period, 278 patients were admitted to the hospice and 56 (20 percent) were using transdermal fentanyl. Of these, 35 (62 percent) were prescribed strong opioid analgesia—the dose of breakthrough medication prescribed was appropriate in 11 patients (31 percent). Rescue dosing was less than recommended, in relation to prescribed transdermal fentanyl strength, in 21 patients (60 percent) and greater than recommended in one patient (3 percent). In this study, short-acting strong opioid analgesia was not always prescribed for patients using transdermal fentanyl, and when they were prescribed, this was in the appropriate dose range in less than a third of patients.
{"title":"Breakthrough strong opioid analgesia prescription in patients using transdermal fentanyl admitted to a hospice","authors":"I. Lawrie, M. Lloyd-Williams, Esther T Waterhouse","doi":"10.1177/104990910302000101","DOIUrl":"https://doi.org/10.1177/104990910302000101","url":null,"abstract":"Durogesic ® (fentanyl) patches have revolutionized pain relief, but patients still require breakthrough medication. A retrospective analysis of in-patient admission notes at a 25-bed hospice over a six-month period was carried out. Details of analgesia being used on admission for both background and breakthrough pain were obtained, and the appropriateness of the breakthrough dose for those patients using transdermal fentanyl was determined. During the study period, 278 patients were admitted to the hospice and 56 (20 percent) were using transdermal fentanyl. Of these, 35 (62 percent) were prescribed strong opioid analgesia—the dose of breakthrough medication prescribed was appropriate in 11 patients (31 percent). Rescue dosing was less than recommended, in relation to prescribed transdermal fentanyl strength, in 21 patients (60 percent) and greater than recommended in one patient (3 percent). In this study, short-acting strong opioid analgesia was not always prescribed for patients using transdermal fentanyl, and when they were prescribed, this was in the appropriate dose range in less than a third of patients.","PeriodicalId":7716,"journal":{"name":"American Journal of Hospice and Palliative Medicine®","volume":"184 1","pages":"1 - 2"},"PeriodicalIF":0.0,"publicationDate":"2003-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80508137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2003-01-01DOI: 10.1177/104990910302000115
Melinda Zimmer-Rankin
American Journal of Hospice & Palliative Care Volume 20, Number 1, January/February 2003 Tool-Kit for Nursing Excellence at End-of-Life Transitions for Nurse Educators (TNEEL-NE), developed by Diana Wilkie, PhD, RN, FAAN, University of Washington School of Nursing, and an interdisciplinary team from the University of Washington and the Massachusetts General Hospital Institutes of Health Professions. Ordering information available at www.son.washington.edu/ departments/bnhs/pain/tneel.asp.
{"title":"Tool-Kit for Nursing Excellence at End-of-Life Transitions for Nurse Educators (TNEEL-NE)","authors":"Melinda Zimmer-Rankin","doi":"10.1177/104990910302000115","DOIUrl":"https://doi.org/10.1177/104990910302000115","url":null,"abstract":"American Journal of Hospice & Palliative Care Volume 20, Number 1, January/February 2003 Tool-Kit for Nursing Excellence at End-of-Life Transitions for Nurse Educators (TNEEL-NE), developed by Diana Wilkie, PhD, RN, FAAN, University of Washington School of Nursing, and an interdisciplinary team from the University of Washington and the Massachusetts General Hospital Institutes of Health Professions. Ordering information available at www.son.washington.edu/ departments/bnhs/pain/tneel.asp.","PeriodicalId":7716,"journal":{"name":"American Journal of Hospice and Palliative Medicine®","volume":"20 4 1","pages":"67 - 68"},"PeriodicalIF":0.0,"publicationDate":"2003-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89681579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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