The Palliative Care Option
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This article appears in the July 2012 issue of HealthLeaders magazine.
The 80-year-old cancer patient wanted to return to his Florida home to die, but the oncologist at the 400-staffed-bed Sarasota Memorial Hospital strongly suggested hormone treatment that required a longer hospital stay.
Eventually, the distraught patient's family intervened for the move home, much earlier than the cancer specialist would have advised. The hospital's palliative care team, which focuses on comfort, pain management, and spiritual assistance for the very sick, helped the patient make the transition to the comfort of home, where he wanted to spend his remaining days.
"There was this purpose of trying to make him live a little longer without anybody really listening to this patient," says Bruce Robinson, MD, MPH, chief of geriatric medicine, and director of the Sarasota Memorial
Hospital Medical Education Committee, who recounts the story of the octogenarian patient as an example of the value of palliative care. "The palliative care service sometimes is called in to try to help families and patients achieve their goals when the system has gotten out of hand," he adds.
Palliative care is among the least understood service lines, not only among patients, but also among hospital staff, including physicians and nurses, Robinson says. One reason this service confuses some medical staff is because palliative care is designed to help the chronically ill, but not necessarily the terminally ill. Indeed, palliative care teams often focus on patients with multiple chronic conditions who require highly specialized and individualized care.
About 40% of the country's hospitals have palliative care programs, many of them composed of multidisciplinary teams where social workers and chaplains work alongside physicians and nurses. Some hospitals have established full-fledged programs within departments, while others include teams who work in other areas of the hospital. Another iteration of this care occurs where hospitals use palliative care outpatient programs to improve patient satisfaction.
Ten years ago there were almost no palliative care programs in America. Today, about 63% of hospitals with 50 or more beds have a palliative care team, the Center to Advance Palliative Care reports. In the past five years alone, access to palliative care in the larger hospitals has more than doubled. The center's 2011 report card shows that the nation gets an overall grade of B for access to hospital-based palliative care, an improvement since 2008 when it received a C.
Overall, palliative care programs have increased 125% over the past decade, according to the American Hospital Association. For hospitals, palliative care is relatively inexpensive because it requires a low start-up investment, with an increasing ROI potential because of projections that more patients—elderly and with chronic conditions—may be suitable for this type of care. Such programs can have an immediate impact on overall resource usage, such as ICU utilization, when patients on palliative care decide to steer away from expensive procedures.
Communities throughout the country are reporting an uptick in palliative care programs, reflecting national statistics on this service. "We have seen a significant growth with the Iowa Health System in developing programs at all affiliate hospitals throughout the state," says Timothy Ihrig, MD, director of palliative care at the Iowa Health System, which has 10 hospitals in Iowa and one in Illinois. "In Fort Dodge, we have seen a 200% growth in monthly consults over the past few months, and it is still growing." Ihrig notes that Medicare reimburses for qualified members, but there are no reimbursements for non-Medicare patients—although Congress has discussed the possibility of changing this rule.
Palliative care is considered relatively new, yet studies reveal that it delivers clinical benefits to patients, who are found to have a higher quality of life and live longer after receiving standard care.
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