Oncology Times:
doi: 10.1097/01.COT.0000290583.47738.00
Clinical Note

CLINICAL NOTES

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▪ 3-Year Hospice Study Makes Recommendation

Access to Hospice Care: Expanding Boundaries, Overcoming Barriers reports the results of a three-year study by a task force from the Hastings Center and the National Hospice Work Group in association with the National Hospice and Palliative Care Organization and an ad hoc group of health policy experts.

The study, The Project on Increasing Access to Hospice Care, was done to find ways to expand and improve end-of-life care by addressing specific problems that impede access and delay patient enrollment.

Published as a 60-page publication, the report offers a comprehensive look at the current state of hospice care policy and practice and recommends ways to improve utilization.

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“Death is an inevitable aspect of the human condition. Dying badly is not,” says the introduction to the lead article that outlines the Project's deliberations and presents eight key recommendations:

▪ Reach a consensus on the definition of palliative care and develop a framework that will allow for greater accountability in delivery and financing.

▪ Expand the scope of hospice services to patients who do not yet qualify for traditional hospice care.

▪ Reform the policy under which the absolute application of prognosis is a primary criterion for reimbursement.

▪ Expand access and delivery of hospice care to long-term care facilities.

▪ Promote hospice-hospital partnerships.

▪ Develop telemedicine to expand access to palliative care.

▪ Engage the business community by pointing out that good care of dying Americans is a workforce issue that relates to productive of employees as patients and as caregivers.

▪ Develop programs to educate the public about the new capabilities, flexibility, and accessibility of hospice and palliative care.

The publication includes eight essays written by task force members who expand on several key issues that surfaced during the deliberations. The topics range from social marketing and the potential impact on public health to health care justice and discontinuity in palliative care.

The report may be ordered by writing or calling The Hastings Center's Membership Department, 21 Malcolm Gordon Rd., Garrison, NY 10524-5555; (845) 424-4040; publications@thehastingscenter.org; or www.thehastingscenter.org. The cost for a single copy is $20, and there is a reduced rate for additional copies.

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▪ Stories from Calvary Hospital

“To cure sometimes, to relieve often, to comfort always” is a 15th century saying that sums up the philosophy of Calvary Hospital. The Bronx-based institution is the nation's only acute care specialty hospital dedicated exclusively to providing palliative care to advanced cancer patients.

Now, there is a book, Stories of Calvary: A Celebration of Life, a collection of stories, letters, and poems by and about patients, their families, and the hospital staff. It is a fitting and useful resource for oncology patients and their families, few of whom could fail to be moved and inspired by the simple yet heartfelt accounts written by people who have learned to accept death even as they celebrate life.

The 95-page booklet is available in return for a donation to the Calvary Fund at Calvary Hospital, 1740 Eastchester Rd., Bronx, NY 10461. Further information is available at www.calvaryhospital.org.

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▪ When Hospitals Divorce

The ill-fated merger between New York University Medical Center and Mount Sinai Medical Center has always been difficult. So is the breakup.

As is the case with many marital divorces, money is the problem. What the two institutions continue to share is debt. In order to completely cut their ties, they would have to redivide their $670 million combined debt. Neither institution is in a strong enough financial position to take on the refinancing this would require.

The merged hospitals do not quality for a Federal Housing Administration (FHA) loan because they have had three straight years of financial losses. Moreover, their bonds were refinanced as part of the merger, and federal tax law disapproves of refinancing debt more than once.

Hospital officials are looking into ways to get around the situation, perhaps by asking the FHA for a waiver or petitioning Congress to change the law.

Meanwhile, costs may actually rise for both hospitals since their cost-effective unified patient-billing office and the joint employee benefits office have been separated.

There are several reasons for what is considered to be the biggest failure of all the New York City hospital mergers that took place in the 1990s. Chief among them was the failure to jointly negotiate better reimbursement from insurance companies and the refusal of departments and their chairs to merge and share power.

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▪ Consequences of Uninsurance

A recently released study by the Institute of Medicine (IOM) has found that the US loses an estimated $65 billion to $130 billion annually as a result of poorer health and earlier death experienced by the 41 million Americans who lack health insurance.

The conclusions of the IOM's 16-member Board on Health Care Services has now been published in a 196-page paperback book, Hidden Costs, Value Lost: Uninsurance in America.

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The “hidden cost” referred to in the title is the amount of money that could be recouped by extending health coverage to all Americans.

“By identifying and, where possible, quantifying the economic inefficiencies and losses that stem from having 41 million Americans without health insurance, the report looks at our national health policy within a cost-benefit framework,” said Mary Sue Coleman, PhD, President of the University of Michigan, who co-chaired the Committee.

“Our findings were based on the same approach the federal agencies use to determine whether the benefits of reducing a particular risk of harm justify the costs to society. As policymakers weigh the costs and benefits of expanding coverage, they should factor in the estimated $65 billion to $130 billion value of improved health that could be realized each year through continuous coverage.”

The report also examines evidence that there are additional costs related to lack of medical coverage that cannot be calculated with current data: higher costs for public programs and a reduction in the availability of health care services for all citizens in communities with high numbers of uninsured.

This publication is the fifth in an IOM series on the consequences of uninsurance sponsored by the Robert Wood Johnson Foundation. It is available by calling the National Academies Press at (202) 334-3313 or (800) 624-6242; or on the Internet at www.nap.edu. The cost is $27 plus shipping charges.

© 2003 Lippincott Williams & Wilkins, Inc.

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