Journal of palliative medicine
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It is unknown how many hospice enrollees elect to be full code and if this is associated with higher hospice live discharge rates. ⋯ Those electing full code status on admission to hospice are at high risk of live hospice discharge after short enrollments, particularly nonwhite enrollees.
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Healthcare payment is rapidly evolving to reward value by measuring and paying for quality and spending performance. Rewarding value for the care of seriously ill patients presents unique challenges. ⋯ We develop recommendations for policymakers and stakeholders about how measures of spending and quality can be balanced in value-based payment programs.
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Many patients with serious illness struggle to talk about the possibility of dying; yet basic prognostic awareness is crucial for informed decision making. In this article, we aim to help outpatient clinicians working with seriously ill patients ambivalent, uncomfortable, or fearful of further discussion about the future. We describe a dual framework that focuses on living well while acknowledging the possibility of dying and equips clinicians to help patients hold both possibilities. This dual framework facilitates the developmental process of living as fully as possible while also preparing for the possibility of dying.
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To document the presence of hospice and palliative physicians in Medicare Shared Savings Program (MSSP) ACOs. ⋯ By rewarding innovation that lowers expenditures, the ACO model encourages attention to care that exhibits high variation and expense. Both hospice and palliative care have been shown to reduce costs and improve the patient experience, making them potentially powerful tools in an ACO's arsenal. However, the MSSP ACO model has not emphasized care of seriously and terminally ill individuals, and thus it is not surprising that there has been consistently low inclusion of hospice and palliative care physicians in MSSP provider networks.
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Home medical care (HMC) patients and their families are expected to prepare for end-of-life decision making. ⋯ Many patients preferred to entrust the end-of-life decisions to others rather than utilizing advance directives, which made surrogates more dependent on doctors for decision making. Qualified advance care planning is required to promote familial discussion and surrogates' decision readiness.