Turner West, director of Education and Community Programs at Lexington, KY-based Hospice of the Bluegrass, discusses how palliative care can drive value at hospitals in areas such as readmissions, mortality, and patient satisfaction.
Americans live in one of the most medically advanced societies in human history. But sometimes, there is no cure for what ails us.
For those times, there is palliative care, which aims to improve quality of life and contain healthcare provider costs for the most costly patients: Those suffering from serious chronic illnesses.
Palliative care, however, is undervalued. But as the drive toward value-based healthcare delivery continues, anything that is undervalued presents an opportunity.
Turner West, director of Education and Community Programs at Lexington, KY-based Hospice of the Bluegrass spoke with me last week as I was preparing for my upcoming webcast, Hospital-Hospice Collaboration to Improve Palliative Care Outcomes. It seemed only fitting to pepper him with questions.
CC: There are several serious chronic medical conditions that have no clear-cut cure. Does US medicine and the broader society need to redefine the common definition of cure?
West: Improvements in public health and advances in medicine have changed the way we die at the population level over the past century and consequently most of us will die from a chronic condition. Some medical conditions can be cured. Some can be treated by medication or interventions such that there is little effect on your day-to-day routine. And other conditions will be debilitating and adversely affect an individual's quality of life.
The patients who benefit most from palliative care are patients living with one or more serious illnesses. Often our palliative care patients have multiple maladies. For example, a patient may have COPD, diabetes, high blood pressure, and other conditions.
They seem to be in a cycle of health crisis, emergency department visit, hospitalization, discharge, and then another health crisis that returns them to the ED.
For this group of patients, honest conversations about prognosis and goals of medical care and effective pain and symptom management are paramount… There is some tension between palliative care and the traditional medical model in the United States, and continuing education about the value of palliative care to seriously ill patients and the health care delivery system is important.
CC: How can palliative care programs drive value at hospitals in areas such as readmissions, mortality, and patient satisfaction?
West: Palliative care is high-quality care for patients and high-value care for hospitals. As a result of effective pain and symptom management and aligning medical treatments with a patient's preferences and values, the hospital experience is transformed both for the patient and the hospital.
For the patient, results of palliative care include improved quality of life, increased satisfaction with the hospital experience, and a discharge plan that reflects a patient's goals of care.
For the hospital, palliative care teams produce better clinical outcomes and more efficient utilization of hospital resources by eliminating intensive treatments that are inconsistent with a patient's goals of care.
CC: The vast majority of palliative care payments to one of your hospital partners, Baptist Health Lexington, come from Medicare. Can palliative care programs help hospitals benefit from value-based Medicare programs such as the Medicare Shared Savings Program?
West: There is literature that demonstrates palliative care is financially beneficial to hospitals, in particular by reducing length of stay and cost per day for complex, seriously ill patients.
More broadly, palliative care tends to be high-value care for the healthcare delivery system as a whole as there is evidence that palliative care reduces unnecessary trips to emergency departments and hospitalizations.
Because palliative care teams deliver high quality care to patients often at a reduced cost, palliative care will be increasingly more important for health systems as payers look to reinforce and reward high-value care.
CC: The interdisciplinary nature of palliative care seems relatively intense, including medical, legal, ethical, spiritual and cultural factors. What are the benefits of gearing a hospital palliative care program with an interdisciplinary team?
West: There are many sources of pain for individuals living with serious illnesses. Palliative care teams are interdisciplinary in order to respond to the total pain experienced by the patient and family.
Palliative care team members bring specialization in pain and symptom management and communication. Both the interdisciplinary composition of the palliative care team and the expertise of the team members are critically important for enhancing the quality of life of patients and families.
CC: Can palliative care programs fill gaps in care that impact quality of life such as unmet pain or symptom needs?
West: Unequivocally, palliative care teams enhance the quality of life of seriously ill patients and their families, and this has been established and corroborated by a large body of medical research.
Palliative care teams have expertise in complex pain and symptom management and in facilitating conversations about prognosis, values, preferences, and goals for medical treatment. Effective pain and symptom management and aligning medical treatment with a patient's goals of care leads to an enhanced quality of life for both patient and caregiver.
CC: Are there psychological and cultural hurdles to be cleared in the field of palliative care inside and outside the medical community?
West: Certainly in the hospice world, many patients receive services very late in their terminal illness, and in many cases this can be ascribed to the patient's or family's unwillingness to come to terms with the fact that death is occurring. Elisabeth Kubler-Ross wrote extensively about our "death-denying" culture.
Advances in medicine and technology also contribute to this sense that there is always something else that can be done to either cure disease or enable an individual to live longer with minimal interference to daily activities.
Certainly there are many examples of this affecting health care, including lack of advance care planning, physicians and other providers avoiding difficult conversations about poor prognosis, underutilization of hospice and palliative services, and aggressive medical care late in life. The key to addressing barriers to palliative care is increased medical and community education.
A HealthLeaders Media webcast, Hospital-Hospice Collaboration to Improve Palliative Care Outcomes, will be broadcast on Thursday, June 12, 2014, from 1:00 to 2:30 p.m. ET. Speakers from Hospice of the Bluegrass and Baptist Health will share tested strategies for building effective hospice-hospital partnerships to improve clinical and financial outcomes.
Christopher Cheney is the CMO editor at HealthLeaders.