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Should We Include Palliative Care in the Reform Debate?

Janice Simmons, for HealthLeaders Media, July 9, 2009

Diane Meier, MD, director of the Center to Advance Palliative Care, was invited to the White House last month for a stakeholder discussion with physicians on the topic of prevention and costs. "I was scratching my head about that one," she said.

According to that great source of knowledge, Wikipedia, palliative care (derived from the Latin word palliare—meaning to cloak) is any form of medical care or treatment that concentrates on reducing the severity of disease symptoms—rather than halting, delaying, or reversing progression of the disease itself or providing a cure. The goal is to prevent and relieve suffering—while at the same time improving the quality of life for people facing serious, complex illness. Palliative care is not considered the same as hospice care.

So what did palliative care have to do with wellness and costs? "Suddenly, it finally hit me—the light bulb went on: They invited me because palliative care is also about prevention of the wrong care," Meier said. In the stakeholders discussion, Meier said she was able to join into the conversation by pointing out "that if we don't prevent the wrong care, there will be no money for anything else."

She explains that palliative care--which is distinct from end-of-life care and from hospice care—is not limited by prognosis. "It has an enormous potential to dramatically improve the quality of care for 23% of Medicare beneficiaries with five or more chronic conditions who drive 67% of total spending," she said.

Recent studies have shown that palliative care can provide clearer treatment goals—redirecting physicians and patients away from more expensive procedures when they are not desired. This can hold down costs—and satisfy the patients with the serious illnesses.

However, the workforce to provide palliative care and the educational assistance for those seeking to make a career in palliative medicine currently is not there. Any mention, though, of palliative care is missing from the two healthcare reform drafts circulating on Capitol Hill—the House tri-committee draft and the Senate House, Education, Labor and Pension draft.

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