The value of palliative care programs

August 8, 2018

Sometimes you have to look past dollars and cents and simply do what makes sense for both patients and physicians.

Editor's Note: Welcome to Medical Economics' blog section which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The opinions expressed here are that of the authors and not UBM / Medical Economics.

Not everything we do as providers needs to generate revenue. Several endeavors can cost the practice money, but improve overall care and are beneficial to patients.

This is also true in an inpatient setting. When it comes to palliative care programs, this is sometimes the case. Palliative care is a concept that over the past several years has been growing in popularity. Providers are beginning to understand the absolute need for palliative services to help with symptom management and clarify goals of care. Per The Center to Advance Palliative Care (CAPC), over 1,700 hospitals with more than 50 beds have a palliative care team at this time, and palliative care is spreading into the outpatient setting as well. Palliative care is addressing the person as well as the disease and is in keeping with the changes occurring in medicine at this time, (such as the Comprehensive Primary Care + model) with a goal of treating social and behavior issues as well as medical issues to improve the care.

The definition of palliative care per CAPC is specialized medical care for people living with serious illness. The goal is to improve quality of life for both the patient and family. The chronic diseases that should usually have a palliative team involved include cancer, dementia, Parkinson’s disease, chronic cardiac disease with congestive heart failure and/or coronary artery disease, amyotrophic lateral sclerosis, and chronic obstructive pulmonary disease, just to name a few.

Palliative care teams often include physicians, nurse practitioners, nurses, and social workers. The team improves quality of life and helps to support the family, the patient, and the specialist or primary care providers. A big goal of the palliative team is to address goals of care and advance care planning. These conversations are often too detailed and time consuming to be done in a 15-minute office visit setting. The team takes the time to have in-depth conversations and answer all questions about goals of care. This often can involve phone calls with out-of-state siblings and children. It is a great help to the primary provider to have a palliative consult that addresses these issues. An important aspect of the palliative provider’s job is communication. The communication is between the patient and family members and often involves the PCP or specialist.

People with serious illness and physical and mental adversity often do not do well under traditional care. Their symptom burden can be left unaddressed. They tend to overuse the ED and have repeat hospital stays. The very ill patient who is not closely followed also may struggle with the increased financial hardship of being a patient. Palliative care teams are crucial for managing difficult symptoms, both physical and mental. For instance, the team helps manage pain, dyspnea, nausea, vomiting, and constipation. They also are key in controlling emotional symptoms as well, such as anxiety, sadness, grief, and anger. There is no doubt that intimate management of these problems improves a patient and family’s quality of life. Patients frequently report overall improved satisfaction with their medical management if palliative care is involved.

Palliative care teams also contribute to reduced readmissions. By checking up on patients shortly after discharge, they are able to catch that three pound weight gain suggesting congestive heart failure, and intervene or see the redness in a leg recurring around a diabetic ulcer and get the patient on antibiotics before the readmission is needed. The team also makes sure the discharged patient is taking their medications correctly which helps with symptom management and decreases hospital bounce-backs.

There is much to be gained by a medical community having a palliative care team available for inpatient and outpatient consults. Not every palliative team will bring financial profit to a hospital system, but the benefit to the patients and families is priceless.

Lori Rousche, MD, is a family medicine physician, practicing in Souderton, Pa., where she operates under the Comprehensive Primary Care Plus model. She is also director of the Grand View Health Hospice and Palliative Care Programs.