22 • CARING FOR THE AGES APRIL 2007 N E W S F R O M Expect Transitions of Care to Top Agenda L ook for transitions of care issues to dominate AMDA’s agenda in the next year. In addition to discussing the Centers for Medicare and Medicaid Services’ Rebalancing Long Term Care Demonstration at the annual symposium in Hollywood, AMDA has been having a dialogue with the American Health Quality Association on how transitions of care might fold into the 9th Scope of Work. AMDA also will be meeting with the CMS Long Term Care Task Force to seek a requirement for a narrative discharge summary to be used across settings, and will be participating in the National Transitions of Care Coalition. AMDA is off to a quick start this year on addressing these issues. In January, the association joined the newly formed National Transitions of Care Coalition, which seeks to improve the quality of care between health care settings. AMDA’s Dr. Richard Schamp, CMD; Jacqueline Vance, R.N., CDONA; and Dr. James Lett, II, CMD, are participating in the work groups on tools and resources, concepts and health policy, and education and awareness. The 9th Scope of Work will not be issued until mid-2008, AMDA has been in discussions with the American Health Quality Association (AHQA), which represents Quality Improvement Organizations (QIO). AHQA likely will propose QIO involvement in transitions of care and AMDA wants to be sure we are supportive of any efforts to improve the quality of care across the long-term care (LTC) continuum. In March, a panel including CMS’ Melissa Hulbert, Dr. Cornelius Foley, CMD, and Dr. Schamp discussed CMS’ Rebalancing Long Term Care Demonstration and its implications for those who practice in LTC settings, such as the PACE (Program of All-Inclusive Care for the Elderly) model. Looking ahead, AMDA will be meeting with the CMS’ Long Term Care Task Force to discuss the use of a narrative discharge summary. In written submissions to the task force, AMDA has asked that hospitals and nursing facilities require a narrative discharge summary written by a physician, nurse practitioner or physician’s assistant, accompany the patient when there is a discharge to a nursing home or home health agency. Look for updates on the task force meeting and our work with the NTOCC in this publication. C fA in action Board Updates CMD Requirements T he American Medical Directors Certification Program (AMDCP) board has adopted initiatives to clarify education requirements. Physicians pursuing certification who have taken a geriatric fellowship must have completed the fel- lowship within 5 years of application. Recertification requires going to at least one AMDA annual symposium during the 6-year certification period. For details, go to http:// www.amda.com/certification/ application_recertification.pdf. C fA T H E A S S O C I A T I O N How to Help the Attending Physician Work With Hospice BY ROBERT MCCONNELL, DO O ver the years, we have heard multiple excuses why physicians don’t refer patients to hospice. Some say it is too expensive, or that the facility can do as good of a job handling appropriate hospice patients, or that the physician loses control when hospice takes over. Others say when they mention the word “hospice,” patients think they are being given a death sentence. Some patients even seem to be dying but don’t have a terminal diagnosis. These issues present a challenge for the medical director who seeks to get physicians to take advantage of the outstanding services of hospice. As the facility medical director, you can successfully address these issues with the attending if you are made aware of the problem. Start with excellent communication with the director of nursing, nurse managers, and social service teams. Have them advise you of problems with the attending when hospice is appropriate and the physician refuses to consider discussions with the patient and patient families. Armed with the facts gathered by the team about the patient’s condition and appropriateness of a hospice referral, begin addressing any of the physicians’ concerns in a closed door meeting. It is usually more effective to have a face-to-face encounter rather than a phone call. Let the attending express all of his or her concerns. You should take notes so you can address each issue, and offer facts to support the referral. Most challenges come from a lack of knowledge about the hospice process including Medicare rules, proper and appropriate admitting diagnoses, and ancillary hospice services. The hospice medical director is a good resource as you address these issues. One of our most difficult processes is in stopping medicine when indicated at end of life. All of our training is in care pathways. Hospice does an excellent job of helping the attending stop treatment when it is no longer needed. After that is resolved, you are ready to partner with the attending on the care team at your facility. The winner in this process is the patient who now has all of the care team functionC ing at its maximum efficiency. fA Mentoring Tips Palliative Care Curriculum Offered A MDA’s Palliative Care Curriculum was introduced at the 30th Annual Symposium. Formatted into two CDROMs, the content includes instructions for teachers, instruction for self-study, slides, and handouts. The second CD contains additional references and Web links for further study. The curriculum is offered as an expansion of the information and materials provided in the Pain and Palliative Care topics of the Primer for Nursing Home Medicine. The Palliative Care Curriculum includes templates for symptom assessments as well as sample forms that can be adapted to the needs of your facility. The curriculum can be ordered at C www.amda.com/order. fA Western Regions Have Smallest Hospice Caseload In Skilled Nursing or Long-Term Care Facilities Opportunities on Ethics Committee he Ethics Committee presents another opportunity for members to get involved in AMDA. Its purpose is to identify issues concerning the ethical conduct of the association and its members, as well as issues regarding the bioethics of health care decisionmaking. It also helps to develop policy statements that are submitted to the board for action. In the past, the committee has worked with the AMDA board of directors to develop a conflict-ofinterest policy, develop a paper on Surrogate Decision-Making and Ad- vance Care Planning in Long-term Care, develop a White Paper on Ethical and Professional Responsibility of LTC Providers in Providing Expert Witness, and provide guidance to the CMD board on composition of an unbiased body to review any submission of a program equivalent to AMDA’s Core Curriculum. Currently, the committee is helping to update the 2000 White Paper on Hospice. To volunteer for this committee, go to www.amda.com/volunteer, or call Kathleen M. Wilson, director of government affairs, at C (410) 740-9743. fA DC Region 1 37.5% Region 2 26.3% Region 3 23.0% Region 4 27.4% Region 5 41.0% Region 6 39.0% Region 7 31.8% Region 8 13.1% Region 9 22.6% Note: Average percentages based on 2005-2006 data from Hospice Salary and Benefits Report. Source: Hospice Association of America E LSEVIER G LOBAL M EDICAL N EWS T Pages 22a—22b佥