"EXCEL" Meeting Minutes
December 11, 2001

Present:
Tim Thompson, M.D., Diana Peirce, Ginny Fry, John Campbell, Maureen Fraser– VPQHC, Madeleine Mongan and Stephanie Lane.

OXYCONTIN:
Ginny Fry asked how often OxyContin is used on patients in Vermont. She explained that she had gone to a conference in NH and they no longer use OxyContin. Diana Peirce responded that we use it some and that she isn’t interested in using only one drug for pain management. Madeleine informed the group that Medicaid is doing a study on what OxyContin is being used for and it is not cancer, but back pain and Fibromyalgia.

Suzie Parker and Jim Rathmell are still working on a prior authorization form. They met with Joe Jacobs and are supposed to be getting the form to the VMS.

Medicaid data has shown that OxyContin use has really dropped off. Diana said that many pharmacists around the area won’t even carry it.

WEB SITE
Tim wants to see a more comprehensive membership list on ExCELs page. The current list is too large. Tim will work with Stephanie and Tassi to weed the list out to only those who participate and are interested in working with the group. Tim also suggested that we include Nursing Home and Hospice Directors as well as Medical Directors all county by county. Diana will call the HPNA for a list of Certified Hospice Nurses. We will also indicated which physicians in the state are Certified Hospice Physicians. Tim listed off those that he could think of: Fran Brokaw, Tom Pendergast, Bob Santulli, Denise Niemira, Skip Linton, Diane Palac, Marylin Hart, John Valentine, Judy Hills, and himself.

Stephanie and Tassi have sent out requests for materials to post on the web site and have had little response as of yet. Tim suggests that we ask the heads of hospice and the medical directors for materials personally. He feels that we are not going to get information without personal contact.

DAD GRANTS
Diana reported that she had received a grant along with Denise Niemira and two others in the Southern part of the state.

LAKE MOREY MEETING
The meeting will be held June 12, and 14th at Lake Morey Inn and Resort. Ginny and Tim will contact DHMC to talk about their meeting being the day before the ExCEL meeting. We need to design a way to form a relationship with DHMC

Don Schomaker, Director of Hospice in Buffalo is willing to speak about children and palliative care. Kathleen Foley has also said that she would attend and speak at the meeting this year. Ginny told the group that she had received notice that Hospice Pharmacia is offering speakers and she will get the list out for everyone to review.

DNR
The job here is to be looking at the order, reviewing it and seeing how it can come together. It will be a lot like the palliative care guidelines. In order for the order to be followed it must be signed and visible with a physician signature.

FINANCIAL
Cannot get financial support to help care for dying patients because the reimbursement rates are so low.

Diana reported on the Hospice Team bill that the NHPC is pushing forward. The bill says that a physician can bill 100% and the hospice team can bill individually at 80%. Diana really thinks that this will happen by spring.

Diana has been going around to Medical Director to show them how to make the money work. Central Vermont Hospice is the most successful hospice in the state.

OTHER BUSINESS
Dartmouth people are interested in attending the next ExCEL meeting.

DHMC has hired ----- to come set up a palliative care program.

Ginny attended a conference in North Carolina on why people of color are not choosing hospice. The effort was focused on trying to move cultural competency. She said that it was an amazing experience that shot down all of her end-of-life care assumptions. Ginny said that we need to ask questions. There should be a focus group with everyone from different cultures to ask about traditions, religions, beliefs………

The California legislature has just passed a law that every physician in the state must be taught palliative care.

NEXT MEETINGS:
January 22, 2002 from 2:00 to 4:00 at VMS
March 5, 2002 from 2:00 to 4:00 at VMS

We will be getting more dates as we coordinate schedules.