GeriPal - A Geriatrics and Palliative Medicine Podcast

• GeriPal Live! at NPCRC Foley Retreat: Dio Kavalieratos, Prasanna Ananth, Alexi Wright

  This is the second GeriPal podcast we’ve recorded live using this format, see this link to our prior podcast at the Center to Advance Palliative Care (CAPC) meeting in Philadelphia.  Also look for our upcoming podcast recorded live from the São Paulo Geriatrics & Gerontology Congress, click here to register. Today we join you from beautiful Banff, Alberta, Canada at the National Palliative Care Research Center (NPCRC) annual Kathleen Foley retreat.  This meeting was bittersweet.  I’ve been fortunate to attend every meeting in one capacity or another since 2006.  The NPCRC made an enormous impact  on the growth and capacity for palliative care research nationally.  Personally, NPCRC funding was essential support as I was a new faculty member and had not yet secured longer term career development funding. More than anything, though, I will miss the NPCRC community.  I treasure those meals, hikes, sing-alongs with others dedicated to improving care of people with serious illness through research. On today’s podcast, we invited Dio Kavalieratos, Prasanna Ananth, and Alexi Wright to join us to talk about three articles that spoke to them.  For each I leave you with a teaser of a hard question that was raised that we couldn’t really answer. Prasanna chose an article by Abby Rosenberg about being fired in palliative care. We talked about why palliative care clinicians get fired, with Prasanna, a pediatric oncologist, raising the issue that it’s more problematic when you’re the oncologist providing primary palliative care and you get fired than if the consultant specialty palliative care provider is fired. Dio chose an article about the economic benefits of palliative care internationally, a call to action.  We talked about the needs of palliative care internationally, and Alexi raised the question: should the highest standard of palliative care (e.g. in the US) apply to palliative care in every country, a la the Partners in Health model pioneered by the late Paul Farmer? Or should we “settle” for access to affordable opioids? Alexi chose an article about cancer care in prison. Alexi used it as a springboard to talk about other populations at compounded risk for poorer care in the current political environment. We hope you enjoy this one as much as we did, dear listeners.  We’re always trying to improve, and welcome your suggestions for how to improve upon this new “live” format.  So far we’ve heard we need to be better at summarizing the articles for the audience/listeners, and finding ways to involve our live audience to a greater extent than the occasional question. Please let us know if you have other suggestions! Final note - check out the wonderful video NPCRC created about their impact on the field of palliative care (Eric and I were filmed recording GeriPal). -Alex Smith   This episode of the GeriPal Podcast is sponsored by UCSF’s Division of Palliative Medicine, an amazing group doing world class palliative care.  They are looking for physician faculty to join them in the inpatient and outpatient setting.  To learn more about job opportunities, please click here: https://aprecruit.ucsf.edu/apply/JPF05811

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• GeriPal Live! at CAPC: Karen Bullock, Kim Curseen, Matt Gonzales

  Eric and I had the pleasure of doing a GeriPal Live! Podcast as the closing keynote for the recent Center to Advance Palliative Care (CAPC) National Assembly in Philadelphia PA. For this podcast, we invited 3 guests to each select an article of interest to them, and engage in a discussion about the article, including questions from the CAPC attendees in the audience. Our guests chose the following articles (in the order discussed) Matt Gonzales used AI to select an article by Ravi Parikh on algorithm based nudges to default patients with advanced cancer into a palliative care consult, published in JAMA Network Open, finding 44% in the intervention arm received palliative care consults, vs 8% in the control arm.  We discussed use of AI to select the article, nudges, sludge, and the impressive though still less than 50% rate of PC consults. Kim Curseen selected an article by Harry Han in JPSM that surveyed palliative care fellowships, finding that clinical fellows spent 5 weeks in outpatient care and 24 weeks in inpatient care, on average.  We discussed the mismatch between outpatient training, and the needs of people with serious illness who spend most of their lives outside the hospital, and training in inpatient care, where most hospitals have robust services and needs. Training in non-onc palliative care was particularly low. Karen Bullock selected a letter she first authored in response to Ira Byock’s white paper on a path forward in hospice and palliative care. We discussed the need to view all issues in geriatrics, hospice, and palliative care through an equity lens, particularly in view of the disparate impact on historically marginalized communities of concerning practices and trends in hospice and palliative care (e.g. private equity gobbling up hospices).  And at the end, we sang a tribute to the Lady Gaga of Palliative Care, with the whole Assembly singing along! Stay tuned for future GeriPal Live! Podcasts, including recordings at the NPCRC Foley Retreat in Banff, and the São Paulo Geriatrics & Gerontology Congress, click here to register.   -Alex Smith  

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• Pre-Operative Geri Assessment: Vicky Tang and Houman Javedan

    We love getting requests from listeners for podcast topics.  This request came from geriatricians we met at the annual American Geriatrics Society meeting in Chicago.  They wanted to know more about what a geriatrician should do in a pre-operative risk assessment.  So we invited Vicky Tang and Houman Javedan, two geriatricians and leaders in the pre-operative assessment and prehab space, to talk with us. As is our style, we backed up to some bigger questions, including: -Why do patients need a geriatric assessment pre-operatively?-Why are our surgical colleagues asking us? Is it due to liability concerns? -Why do we do them?  Recognizing we may have different motivations than our consultants (hint: stealth geriatrics) -How does the comprehensive geriatric assessment fit int? Do the 4Ms fit into pre-operative assessment if at all? (an entertaining disagreement ensued) -Must a geriatrician do this? -What is the Geriatric Surgery Verification Program? -What’s the most important part of  Many links from our guests below. And please forgive my Spanish on the song, I tried! Thanks to sons Kai and Renn on Ukulele and Bass for making it sound better. -Alex From Vicky: Systematic review of Prehab https://pubmed.ncbi.nlm.nih.gov/39655991/ Geriatric Surgery Verification Program https://www.facs.org/quality-programs/accreditation-and-verification/geriatric-surgery-verification/  shared decision making in surgical patients https://pubmed.ncbi.nlm.nih.gov/40551447/  From Houman: Geriatric Surgical Co-management Evidence 1.    Trauma survival with geriatric assessment 2022- https://pubmed.ncbi.nlm.nih.gov/36102764/ 2.    Hip fracture survival benefit meta-analysis 2014- https://pubmed.ncbi.nlm.nih.gov/23912859/ 3.    Elective abdominal surgery benefits POSH program 2018- https://pubmed.ncbi.nlm.nih.gov/29299599/ 4.    POSH Program for Spine 2021- https://pubmed.ncbi.nlm.nih.gov/33382460/ 5.    Elective orthopedic joints ED readmission decreases 2024 - https://pubmed.ncbi.nlm.nih.gov/39715294/ 6.    The need for geriatricians, tools and education models (aka Ms) are not enough - https://pubmed.ncbi.nlm.nih.gov/30916758/ Sub Topics 7.    Utility of minicog and where our improved local mortality of 18% and delirium of 11% reported - https://pubmed.ncbi.nlm.nih.gov/27147687/ 8.    Geriatrician performed CGA-FI best at predicting mortality in rib fractures 2025 - https://pubmed.ncbi.nlm.nih.gov/39800638/ 9.    Geriatrician performed CGA-FI predicting mortality better than age in hip fractures 2024- https://pubmed.ncbi.nlm.nih.gov/39007664/  10.  Multidomain frailty assessment and surgery showing severely frail patients at risk of mortality even with low risk procedures (eg. Cystoscopy) - https://pubmed.ncbi.nlm.nih.gov/31721994/ 11.  Different outcomes for hip fracture surgery in the severely frail - https://pubmed.ncbi.nlm.nih.gov/38892908/ 12.  Complexity of aging physiology- example of prostaglandin based free water excretion in collecting duct of aging kidney first paragraph on page 360- https://pubmed.ncbi.nlm.nih.gov/36948780/   

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• What Makes a Good Death? Karen Steinhauser, Rasa Mikelyte, Edison Vidal

  What is a “good death”? How should we define it, and who gets to decide? Is the concept of a “good death” even useful? Twenty-five years ago, Karen Steinhauser published a groundbreaking study in JAMA that transformed my understanding of what it means to have a good death and questioned the usefulness of the term itself. This study examined the factors that are important at the end of life for patients, families, physicians, and other healthcare providers. In today’s podcast, we are honored to have Karen join us to discuss this pivotal study and the nature of a “good death”. We are also joined by Rasa Mikelyte and Edison Vidal, co-authors of a recent study comparing the perspectives of people with dementia in the UK and Brazil on what constitutes a good death. In addition to exploring the nature of a good death and their individual studies, we will discuss: Whether an external criterion for a good death exists, or if it is entirely dependent on the perspective of the dying individual. The role of culture and spirituality in defining a good death. The role of healthcare providers in the discussion about the nature of a good death. Key references we discuss include: Our previous GeriPal podcast, “Should the Concept of ‘The Good Death’ Be Buried?” with VJ Periyakoil. Karen’s 2000 JAMA article, “Factors Considered Important at the End of Life by Patients, Family, Physicians, and Other Care Providers.” Rasa and Edison’s article, “Comparing the Views of People with Dementia in the UK and Brazil about a Good Death.” A short video from the EPEC project that Edison mentioned during the recording of an interview with Cicely Saunders, where she shares her advice for anyone going into medicine or palliative care and her views about the principles of palliative care. Lastly, if you would like to join Eric, Edison, and I in Brazil on April 6, 2026, for the São Paulo Geriatrics & Gerontology Congress, click here to register. -Alex Smith

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• Medical Billing and Coding with the "Billing Boys"

  A podcast on medical billing and coding??? Ok, hear us out as we were skeptical too. We’ve invited the Billing Boys, Chris Jones and Phil Rodgers, who convinced us of the following: Billing is complicated, but it isn’t hard.  Effectively billing helps pay for the interprofessional team members who often can't bill We should know our worth and bill for it. Just because a visit didn’t feel HARD to a well-trained provider doesn’t mean it wasn’t complex or valuable.  Many of us have long suffered from low professional self-esteem when it comes to money, and it’s high time we stop that. While exclusively billing on time may have been right 20 years ago, we must now understand complexity and advance care planning (ACP). We can't cover everything in the 45 minutes we are together, so here are some of the resources we reference in the podcast: Chris’s and Phil’s consulting contact info via Lightning Bolt Partners CAPC resources: CAPC’s Billing and Coding Toolkit CAPC’s Monthly office hours in Inpatient and Community-Based PC Billing and Coding run by Andy Esch, Phil Santa Emma, and Chris Jones CAPC’s 2025 Annual Billing and Coding Update done by Phil and Chris each year Advance Care Planning resource from the Medicare Learning Network Top Ten Tips for Using Advance Care Planning Codes  CPT 2025 Professional Edition. This is the book that has the Complexity Grid in it. The answers are all here! And your coders will likely share.                

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