Financial and Administrative Obstacles to End-of-Life Care Task
Force
There was a discussion of the Medicare Prospective Payment System,
which was put in place effective October 1, 2000. A suggestion was
made to create an ExCEL task force on financing for end-of-life care
to review all options for financing and the effect of reimbursement
changes such as PPS on palliative care, hospice and home health
services. Dr. Thompson asked for leadership from Ginny and Diana on
finances and obstacles to providing good palliative care, because
Central Vermont has effectively addressed this issue. Ginny, Diana,
& Tim will be on this task force. Stephanie will send a message to
the Listserve asking for other volunteers for the Task Force. Tim
will ask Paul Bergston if he would be on Task Force.
Language
Dr. Golodetz will lead an effort to get agreement on terms and
language for palliative care and end-of-life care. He would like to
address advanced chronic illness. Dr. Golodetz will draft a proposal
on this issue and send it to the list serve.
Combined Conference:
Hospice/ExCEL- June 2001 - Lake Morey
Panels: for the breakout sessions at June meeting on Thursday
afternoon will include:
- Education-physician, hospice
- Education-payors
- Medicaid, Medicare issues
- Finances
Tim Quill, M.D., will speak Thursday
morning on non-abandonment. Joan Madison is trying to invite him
also to speak at Grand Rounds at FAHC on Friday.
Dr. Thompson asked about funding for
the hospice/ExCEL conference next summer. Dr. Thompson will call Dr.
Niemira about contacting drug companies. We also need to broaden the
list of invitees for June Meeting. It was suggested to invite
nursing home directors to the conference.
Grand Rounds at FAHC
Ginny did Grand Rounds at FAHC with Matthew Gutierrez, Chief Medical
Resident on November 18th. The topic was "Sharing Bad News" and
there was a full house, and lots of questions about things that have
gone badly for patients: too many words; too much lingo; not
listening. Madeleine will investigate whether there is a way we
could put this information on the ExCEL Listserve since it was
broadcast on Telemedicine. She will call Jessica Comai or John
Brumstead to see if this was taped or if there is a transcript.
Tim will contact Dr. Brumstead to see
if FAHC will finance statewide distribution of Zail's flip book on
sympton management.
CEO Letter
Dr. Golodetz talked about identifying and contacting local people to
follow up on the CEO letter. They will be more likely to respond to
local initiatives. We should contact people who are part of a local
palliative care effort to ask them to approach their CEO, for
example Judith Kinley at Brattleboro; and Barbara Fane and Barbara
Raskin, M.D. in Bennington. Newport, St. Johnsbury and Central
Vermont are all set. All regional leaders should be invited to the
June meeting. This issue should be added to the agenda for the next
ExCEL meeting. ExCEL members should review the ExCEL member list on
the web site www.vtmd.org to help identify who should be added or
dropped from the list to ensure that we have all regions
represented.
Nursing Home Meeting
Dr. Thompson spoke with nursing home directors, social workers,
nurses on October 3rd at Killington. There is a need for a protocol
in nursing homes on standing orders for pain and symptom management
and also a protocol on how nursing home patients enter into
End-of-Life mode. Next steps: Should we identify a successful model
in one or two sites or should we focus on creating a centralized
model. We need to develop a program or document to help families
choose aggressive treatment or home care (step back).
Resources:
Dr. Golodetz noted we need competent person to help build the
regional end-of life care network $50,000 minimum (salary for 3
years would be $150,000). We need to develop a proposal to use to
contact the Freeman Foundation. Dr. Reardon may be helpful. Dr.
Golodetz will contact her. Dr. Hartley Neal may be another resource
as he has a connection with Mr. Freeman . Dr. Thompson will contact
Dr. Neal.
Before next meeting:
Everyone should look at ExCel member list on the web and contact
Stephanie or Madeleine about adding or deleting members.
VPQHC:
Madeleine will talk to Helen Riehle or Dr. Jordan to see whom we
should talk to about the quality page this year. Madeleine will
invite Julie Tonks from VAHHS to next ExCEL meeting conference call.
Next meetings:
All conference calls will use the same dial up number (800-852-7711)
and conference code (37898)
All meetings at the VMS will be held
in the carriage house conference room
- Thursday January 18, 2001 7:30a.m.
- 9:30a.m. Conference Call
- Thursday February 22, 2001
7:30a.m. - 9:30a.m. Conference Call
- Tuesday March 27, 2001 2:00p.m. -
4:00p.m. At VMS
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