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10/31/2015

“Choosing Wisely” Report Card

Some early data has come out on the efficacy of the Choosing Wisely campaign. The research focused solely on whether medical practices targeted by the campaign were reduced in frequency.  The findings [Rosenberg A, Agiro A, Gottlieb M, et al. Early Trends Among Seven Recommendations From the Choosing Wisely Campaign. JAMA Intern Med. Published online […]

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This entry was posted in Health Care and tagged , . Posted by denasdavis. Bookmark the permalink.

10/31/2015

The Lazarus Effect [EOL in Art 173]

A number of brain death disputes are pending in US courts this month.  So, the new film The Lazarus Effect seems timely.   Reminiscent of Pet Cemetery, this film follows a group of researchers who have achieved the unimaginable - bringi...

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This entry was posted in Health Care and tagged , . Posted by Thaddeus Mason Pope. Bookmark the permalink.

10/31/2015

Medicare Reimbursement for Advance Care Planning – FINAL RULE

Yesterday, the Centers for Medicare & Medicaid Services issued a final rule updating payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule on or after January 1, 2016.

Notably, the rule establishes separate payment and a payment rate for two advance care planning services provided to Medicare beneficiaries by physicians and other practitioners.  I posted the relevant section from the >1300-page rule here.  

The Medicare statute currently provides coverage for advance care planning under the “Welcome to Medicare” visit available to all Medicare beneficiaries.  But they may not need these services when they first enroll. Establishing separate payment for advance care planning codes to recognize additional practitioner time to conduct these conversations provides beneficiaries and practitioners greater opportunity and flexibility to utilize these planning sessions at the most appropriate time for patients and their families. CMS is also finalizing payment for advance care planning when it is included as an optional element of the “Annual Wellness Visit.”

The AMA Current Procedural Terminology (CPT) Editorial Panel and the AMA Relative Value Update Committee (RUC) recommended new CPT codes and associated payment amounts for calendar year 2015. CMS did not make the new codes payable for 2015 in order to allow the public full opportunity to comment.

For Medicare beneficiaries who choose to pursue it, advance care planning is a service that includes early conversations between patients and their practitioners, both before an illness progresses and during the course of treatment, to decide on the type of care that is right for them.

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This entry was posted in Health Care and tagged , . Posted by Thaddeus Mason Pope. Bookmark the permalink.

10/30/2015

MNHPC Fall Forum – Addressing Ethical Issues at the End of Life

On November 12, join the Minnesota Network for Hospice and Palliative Care for its Fall Forum: Addressing Ethical Issues at the End of Life.

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This entry was posted in Health Care and tagged , . Posted by Thaddeus Mason Pope. Bookmark the permalink.

10/30/2015

Right Way and Wrong Way: Making an Immediate Ethical/Legal Medical Decision






This thread is about what is the ethical and legal "right way" and what is 
the "wrong way"  for doctors and nurses in an emergency room to respond when they are in the act of attempting to save a patient's life and then after resuscitation, started earlier by the paramedics, and was in progress was told by the patient's surrogate to stop at once and let the patient die, not allowing the opportunity to taper off the resuscitation and observe possible recovery.  Here is the scenario as written as the Case Study in the September-October 2015 issue ofthe "Hastings Center Report" for which I have received permission to reproduce here. 


Robert F. is an eighty-five-year-old who suffered a heart attack at home in a rural location some thirty minutes from any major hospital. By the time the paramedics arrived, he was unconscious and nonresponsive. After spontaneous return of circulation, they began their standard procedure of therapeutic hypothermia. Robert's core temperature was lowered using ice packs, and cold intravenous fluids were initiated. Soon afterward, Robert started to shiver when his body temperature reached 35.6° Celsius. He was then given a bolus of vecuronium as a neuromuscular blockade, sedated, and intubated. He was also given a low-dose vasopressin for blood-pressure control. Shortly after Robert arrived in the emergency room, his daughter, his medical decision-maker, produced an advance directive documenting that her father has a do-not-resuscitate (DNR) order, and she demanded that the breathing tube and any other life-sustaining treatments be withdrawn immediately.

The medical staff is very reluctant to comply with this demand for immediate action. Until the neuromuscular blockade wears off, removing the ventilator will prevent Robert from breathing. Furthermore, it may take some time to reverse the therapeutic hypothermia procedure to the point that the patient is at normal temperature. In addition, therapeutic hypothermia itself often causes arrest, so the patient may need to be resuscitated again.



Should the staff wait until the patient is warm or honor the decision of his daughter, who holds his medical power of attorney?


To stop all resuscitation at once will cause the patient to die while being professionally treated and the patient's status for surviving without injury would remain unestablished. This obviously was a moral "no no" by the doctors and nurses since this act at this time might represent to them as unprofessional "killing" of the patient.   On the other hand, to not follow the request of the patient through an advance directive for medical care and the demand of the surrogate daughter, would mean that the doctors and nurses were ignoring the legal and ethical autonomy  of the patient.


So tell me, which is the "right way" and which is the "wrong way" for those medical professionals to act.  ...Maurice.


Graphic: From Google Images


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This entry was posted in Health Care and tagged . Posted by Maurice Bernstein, M.D.. Bookmark the permalink.

10/30/2015

Right Way and Wrong Way: Making an Immediate Ethical/Legal Medical Decision






This thread is about what is the ethical and legal "right way" and what is 
the "wrong way"  for doctors and nurses in an emergency room to respond when they are in the act of attempting to save a patient's life and then after resuscitation, started earlier by the paramedics, and was in progress was told by the patient's surrogate to stop at once and let the patient die, not allowing the opportunity to taper off the resuscitation and observe possible recovery.  Here is the scenario as written as the Case Study in the September-October 2015 issue ofthe "Hastings Center Report" for which I have received permission to reproduce here. 


Robert F. is an eighty-five-year-old who suffered a heart attack at home in a rural location some thirty minutes from any major hospital. By the time the paramedics arrived, he was unconscious and nonresponsive. After spontaneous return of circulation, they began their standard procedure of therapeutic hypothermia. Robert's core temperature was lowered using ice packs, and cold intravenous fluids were initiated. Soon afterward, Robert started to shiver when his body temperature reached 35.6° Celsius. He was then given a bolus of vecuronium as a neuromuscular blockade, sedated, and intubated. He was also given a low-dose vasopressin for blood-pressure control. Shortly after Robert arrived in the emergency room, his daughter, his medical decision-maker, produced an advance directive documenting that her father has a do-not-resuscitate (DNR) order, and she demanded that the breathing tube and any other life-sustaining treatments be withdrawn immediately.

The medical staff is very reluctant to comply with this demand for immediate action. Until the neuromuscular blockade wears off, removing the ventilator will prevent Robert from breathing. Furthermore, it may take some time to reverse the therapeutic hypothermia procedure to the point that the patient is at normal temperature. In addition, therapeutic hypothermia itself often causes arrest, so the patient may need to be resuscitated again.



Should the staff wait until the patient is warm or honor the decision of his daughter, who holds his medical power of attorney?


To stop all resuscitation at once will cause the patient to die while being professionally treated and the patient's status for surviving without injury would remain unestablished. This obviously was a moral "no no" by the doctors and nurses since this act at this time might represent to them as unprofessional "killing" of the patient.   On the other hand, to not follow the request of the patient through an advance directive for medical care and the demand of the surrogate daughter, would mean that the doctors and nurses were ignoring the legal and ethical autonomy  of the patient.


So tell me, which is the "right way" and which is the "wrong way" for those medical professionals to act.  ...Maurice.


Graphic: From Google Images


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This entry was posted in Health Care and tagged . Posted by Maurice Bernstein, M.D.. Bookmark the permalink.

10/30/2015

Does the Thought of Money Make Us Dishonest?

Here is a game you can’t lose. You flip a fair coin ten times and every time it comes up heads, you get $20. Better yet, I won’t even watch you flip the coin, but instead will trust whatever you … Continue reading

The post Does the Thought of Money Make Us Dishonest? appeared first on PeterUbel.com.

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10/30/2015

Florida Tries Again for POLST Legislation

While Florida failed to enact POLST legislation last session, it is trying again.  Newly filed S.B 664 would: Require the Department of Health to develop, and adopt by rule, a physician order for life-sustaining treatment (POLST) form Require th...

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This entry was posted in Health Care and tagged , . Posted by Thaddeus Mason Pope. Bookmark the permalink.

10/30/2015

Schubert Adagio "The Entrance to Heaven" [EOL in Art 172]

A brief excerpt from the film "L'amour de la vie" (1969).

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This entry was posted in Health Care and tagged , . Posted by Thaddeus Mason Pope. Bookmark the permalink.

10/30/2015

Medical Ethics and School Football

by Steven H. Miles, MD and Shailendra Prasad, MD, MPH

This is a special pre-print posting of an editorial scheduled for the January 2016 issue of the American Journal of Bioethics.

Health professionals should call for ending public school tackle football programs. We disagree with the perspective and the argument of a recent report by the American Academy of Pediatrics (AAP) that supports the current organization of reforms of youth tackle football.

About 1.1 million students play on junior and high school football teams. Another three million play in non-school programs. Youth football is slowly dying. The number of players on junior and high school football teams has fallen 2.4% over the last 5 years.…

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This entry was posted in Featured Posts, Sports Ethics and tagged . Posted by Steven Miles. Bookmark the permalink.