ACP Decisions

"In a recently published study I found that patients are right to worry: Doctors do judge patients negatively based on the accuracy of what they say. My colleagues and I surveyed more than 200 primary care doctors, giving them hypothetical questions about patients who shared beliefs of varying correctness. We found that doctors viewed patients more negatively the more incorrect their beliefs."

"Massachusetts Institute of Technology (MIT) researchers analyzed Medicare fee-for-service claims spanning between 1999 and 2019, including data on hospice billing, patient enrollment, hospitalizations, health costs and chronic condition indicators. Roughly 14.7% of ADRD patients utilized hospices services in 2019, nearly triple the 4.4% of patients who received this care in 1999, according to the research, which was published in the National Bureau of Economic Research. ... Hospice services delivered by for-profit providers resulted in an estimated $29,000 in Medicare savings for each ADRD patient over the course of five years post diagnosis, the research found. Much the reduced spending was driven by longer hospice stays and less utilization of inpatient, skilled nursing and home health services as well as decreased pharmaceutical spending, the researchers indicated."

" .... [S]ome low-value care services (ie, cervical cancer screening among women older than 65 years and low-value thyroid testing) were lower among practices with high telehealth use, and there was no association between practice-level telehealth use in rates of most other low-value care services not delivered in the office. As telehealth continues to be an important part of care delivery, evaluating how it may encourage or discourage low-value care services is critical to understanding its impact on quality of care."

"This evaluation of the SIP has 2 principal findings. First, and overall, there appears to be no statistically significant differences in surgeon workforce during or after the payment incentive. Second, a more granular geospatial evaluation suggests heterogeneity of policy effect, with a portion of eligible counties demonstrating statistically significant increases in surgeon workforce while others saw notable decreases."

The Drug Enforcement Administration (DEA) will extend pandemic-era telehealth prescribing flexibilities for one year, through Dec. 31, 2025, according to an unpublished rule that hit the Federal Register on Friday night.

"In the current environment, working to recenter medical care around patients’ interests can be difficult or even dangerous, but it is the only path forward if physicians hope to remain a true profession."

"There were 8297 ovarian cancer decedents. Their mean (SD) age at death was 69.6 (13.1) years, and their mean (SD) oncologic survival was 2.8 (3.9) years. Among 3958 patients with known cancer stage, 3495 (88.3%) presented with stage III or IV disease. One-third of patients (2667 [32.1%]) received late palliative care in the final 3 months of life. Results of multivariable regression analysis indicated that any palliative care initiated earlier than 3 months before death was associated with lower rates of aggressive end-of-life care (odds ratio [OR], 0.47 [95% CI, 0.37-0.60]), death in hospital (OR, 0.54 [95% CI, 0.45-0.65]), and intensive care unit admission (OR, 0.46 [95% CI, 0.27-0.76]). Specialist palliative consultation from 3 months up to 6 monts before death was associated with decreased likelihood of late chemotherapy (OR, 0.46 [95% CI, 0.24-0.88])."

"Native Hawaiian and Pacific Islander participation in the clinical trials analyzed in this study was either unknown or minimal, suggesting that purposeful strategies for Native Hawaiian and Pacific Islander inclusion are needed, including establishing recruitment sites in key areas such as Hawai‘i with a large Native Hawaiian and Pacific Islander population."

"Just weeks or even days or hours away from death, the majority of conscious terminally ill patients often experience growth and meaning in their lives and the absence of fear through end-of-life dreams and visions, according to research by Christopher W. Kerr, MD, PhD. Dr. Kerr is Chief Executive Officer and Chief Medical Officer of Hospice and Palliative Care Buffalo, New York, and coauthor of Death Is But a Dream: Finding Hope and Meaning at Life’s End (Avery, 2020)."

"A study of 1,250 people with advanced lung cancer found that virtual and in-person palliative care were similarly effective in improving patients’ quality of life and other important measures of well-being, according to findings published September 11 in JAMA. It also found benefits for caregivers."