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The future of palliative care - Issue #6

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A number of my friends keep telling me that the future is about payment. Well, this issue is for you
 

The future of palliative care

April 1 · Issue #6 · View online
In many respects, we've arrived. Yet what we know now won't get us to the next level. So I'm looking for signals from the future, & I'm curating them here.

A number of my friends keep telling me that the future is about payment. Well, this issue is for you :)

1. How values turn into goals.
The current palliative care rhetoric about ‘treatments that match values’, elides a complicated step about how one gets from values to goals. We clinicians do this, all the time–but without much empirical grounding. In this study asking how people value health states, subjects 'concretized’ and 'interpreted’ health states; then applied 'conversion factors’–things that affect the valuation process. These conversion factors came in 4 flavors: personal circumstances, other people’s reactions, one’s ability to adapt, and available support. A small study, to be sure, but evocative, e.g. 'how is your spouse’s reaction shaping your thinking?’
How do individuals value health states? A qualitative investigation - ScienceDirect
2. HHS moves forward on alternative payment models.
On March 26, the US Dept of Health and Human Services PTAC (Physician-focused Payment Model Technical Advisory Committee) voted to recommend two alternative payment models, one developed by the Center to Transform Advanced Care the other by the American Academy for Hospice & Palliative Medicine. To cut to the chase: this is the first big policy that supports payment for palliative care since the hospice benefit for Medicare was passed in 1982. This could be a game-changer. More to come, as these 2 payment models will likely be merged, but to all of you that have made this possible: wow, thank you.
3. The limits of capitalism as the basis for healthcare.
Despite my interest in a payment model for American health care that is other than fee for service, I still own some deeply held capitalist assumptions–and this account of the faltering British NHS shook me up. A beautiful longform read about care in a system that is coming apart for very different reasons than ours–‘the spirit of postwar communitarianism’ transformed into a debate about waste. (This despite the largely positive look at 'place-based’ approaches to payment reform in JAMA March 30. Heartbreaking. 
James Meek · NHS SOS · LRB 5 April 2018
4. Now in paperback, the ugly side of the US market.
If you haven’t yet read Elisabeth Rosenthal’s jaw dropping account of healthcare as a big business, it just came out in paperback. She’s the editor of Kaiser Health News, a dogged reporter, and her book is a devastating synthesis (the Washington Post called it ‘gruesome’) of how the market side of US health care distorts and undermines the real work of care. And it is unsparing, even for physicians–what i read about my profession made me wince. A must-read.
An American Sickness: How Healthcare Became Big Business and How You Can Take It Back: Elisabeth Rosenthal: 9780143110859: Amazon.com: Books
5. Now, how to keep going?
Finally, a moment of repose. Austin Kleon, author of Steal Like An Artist, gives a fantastic talk at the Bond 2018 conference in SF about how to stay creative in chaotic times. Recommendation #9: The demons hate fresh air. Made me smile, more than once. For your future self.
26 minutes, and worth it.
This newsletter is made possible by the John A Hartford Foundation, and especially the amazing Amy Berman. But the opinions, views, & recommendations are mine alone. 
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