AAHPM Assembly 3/5/2010
March 5, 2010 by hospicephysician
Today is officially day 2 of the conference (this is day 3 for me as I participated in some of the preconference workshops). I appreciated another great day today. In addition to the great speakers and networking with new people, I was able to catch up with old friends and colleagues. For this reason I am sad I was unable to attend the Pallimed/Geri-pal meet and greet. Maybe next year! Listed below are several take home messages I learned today.
1. “Caring for the Patient with ALS: It Takes a Village.” I have taken care of ALS patients and even though I haven’t been practicing long, I’ve probably seen more ALS patients in hospice than most primary care physicians in practice. This is most likely due to the prolonged relationships that patients develop with their primary team of Neurologists and other providers much like cancer patients become very attached and involved with their oncologist and their staff. There was a nice overview of ALS and how a certain hospice program has made ALS a focal point in their care. As they have learned more about ALS, educated their staff and worked within the VA system they have seen their referrals increase. They encouraged hospices to be more involved and if possible work in partnership with the VA system to take care of this unique population. They pointed us to a great website for resources and further information. The ALS Association; http://www.alsa.org.
2. Gail Sheehy, Guest Speaker and author of “Passages in Caregiving: Turning Choas into Confidence.” She talked about her journey with her husband as he battled cancer, over a prolonged period of time, prior to his death. Her story was touching as she told it and explained the role of palliative care in the impact of care not only for her husband but also for herself. She also agreed that many people don’t know what palliative care is, and think that palliative care = hospice (I cringe every time a physician talks about palliative care in regards to End-of-Life Care).
3. Paper Session.
a. There is an increased need for Outpatient Spiritual Care as this paper shows that patients receiving Outpatient Palliative Care want Spiritual Care to be part of their medical care.
b. The significant majority of Outpatient Palliative Care programs are associated with an Inpatient Palliative Care programs. What surprised me is that most Palliative Care programs are associated with smaller hospitals and most are tied to Non-for-Profit Hospitals.4. “Physician Compensation Models.” Very unique discussion. Still many unanswered questions about how to fairly reimburse physicians in hospice and palliative care. It mostly breaks down into two models, Salaried versus Incentive based. What was unexpected to see, and caught me by surprise, was the number of physicians being salaried by their respective hospices. Also, many more hospices are beginning to employ physicians Full-Time versus part time or as independent contractors. Both types of reimbursements have advantages and disadvantages; however, an argument could be made that a hybrid model may be able to make both parties happy and minimize the disadvantages. This model would include a lower based salary with benefits but a percentage of the physicians compensation would be incentive based. By this, they would be reimbursed a portion of their income based on the number of patients seen per week or month or however it is worked out. There will be much information to follow in the future months and years as more physicians converse about this topic.
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Perhaps the compensation model would be more efficient with clearly defined expectations. Incentives lend themselves to "doing" to get paid not because of need. However, this is the real world and incentives enhance the productivity of the staff. I suppose the work lies in developing appropriate incentives.
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