A To-Do List for the New CEO of the Federal Health Insurance Marketplace

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the program will expand to an additional 45 social workers, chaplains, nurses, and physicians. Major health systemsare also takingup the challenge. The Mayo Clinic has created amedical notedocumentingadvancedcare planning discussions between physicians and patients; these will be included in electronicmedical records and accessible to clinicians across clinic settings beginningnext year, said Cory Ingram, MD, medical director of palliative care at the Mayo Clinic in Rochester,Minnesota.Also, theMayoClinic is exploringusing telemedicine tobringpalliative care expertise into rural areas or to members of theMayo Clinic Care Network, as needed. “Palliative care is not esoteric,” Ingram said. “It can take a central role in the health caredelivery systemconcurrentwithhighly sophisticated, technologically advanced care, andMayo is committed to that across our system.” InTexas,BaylorHealthCareSystemhas achieved advanced certification in palliative care from the Joint Commission for medical centers inDallasandFortWorthand eventually plans to develop interdisciplinary palliative care teams at all of its hospitals. Two outpatient palliative care clinics haveopened inDallasandPlano,andthesystem is offering 9 hours of training in palliative medicine to hospitalists—the start of a targeted effort to educate specialists in the discipline. “We are trying to extend palliative care across the continuum of care, just like the IOM report recommends,” sa id Robert Fine, MD, Baylor’s clinical director for palliative care. He said the report provides much-needed support for these efforts. “Now, I can go to the hospital president and say ‘Hey, it’s not just Bob Fine talking about what we need to do: it’s the IOM.’”