Trends in Palliative Care: Looking Ahead to 2019

Palliative care in US hospitals has risen steadily over the past 16 years, with more than three-quarters of the nation’s hospitals and health systems offering programs, according to a recent report from the Center to Advance Palliative Care. However, many who would most benefit from palliative care simply don’t have access to it, which can ultimately diminish patients’ quality of life while simultaneously driving up healthcare costs.

Crossroads Hospice & Palliative Care has long advocated the solution and today leads the trend: bring true, patient-directed, palliative care into the community, meeting individuals where they are on their personal healthcare journey.

An Issue of Access

Palliative care – compassionately treating those with chronic, life-limiting illnesses according to their individual priorities and life goals – can be empowering for people and significantly increase quality of life at the end of life, says Crossroads Chief Medical Officer Timothy Ihrig, MD.

The upward trend in hospital-based palliative care programs is a step in the right direction as the nation’s health systems navigate the transformation from volume- to value-based healthcare. Numerous studies have demonstrated that palliative care programs increase patient satisfaction, as Dr. Ihrig points out. They also reduce costs and lead to better patient care overall, the guiding aims of healthcare transformation.

However, availability varies state by state, with most programs concentrated in major cities with academic medical centers and large health systems. Among those hospitals that do offer palliative care services, only a small fraction of the sickest patients who could most benefit actually receive palliative care, according to the CAPC’s 2015 State-by-State Report Card. Many in-hospital palliative care teams are understaffed and stretched to thinly to be able to see every hospitalized patient that would benefit from their services.

Findings from a landmark Institute of Medicine study on the drivers of healthcare costs at end-of-life are particularly relevant to any discussion of the value of increasing access to palliative care. To briefly summarize, five percent of Medicare beneficiaries account for half of the entire Medicare spend each year. These are the sickest, most vulnerable patients, and also the costliest to our nation’s healthcare system. Of that five percent, 40 percent are seriously, chronically ill people with multiple, complex health issues, often compounded by dementia and other age-associated problems.

These are exactly the people who would most benefit from receiving palliative care, experts agree. But without access, these patients too often wind up calling 911 and receiving care through hospital emergency departments, which are among the costliest settings for care delivery, and are frequently re-admitted to the hospital.

Community-based Service Models – A Growing Trend

The answer, healthcare leaders say, is to bring the right level of care to people at the right time and in the right setting, not necessarily within hospital walls. This is the fundamental tenet of population health, and it applies across the entire healthcare journey, from birth to death.

This means extending palliative care across the entire healthcare continuum as Crossroads does, into community settings like long-term skilled nursing and assisted living facilities, and patients’ homes. Palliative care specialists now see patients in community health clinics and primary care physician practices.  Many health systems have begun embedding palliative care specialists in their outpatient clinics, oncology and cardiology practices in particular. Telemedicine further expands access to palliative care.

Through skilled discussion of patients’ goals of care, and by addressing pain and distressing symptoms of chronic illness, attending to patients’ emotional and spiritual needs, and coordinating care, community-based palliative care specialists like Crossroads help meet patients’ needs and avoid unwanted and costly crisis care.

A Sound Investment

Meeting patients with palliative care in the community and “where they are” on the care continuum prevents unnecessary hospitalizations; decreases inpatient stays, readmissions and total cost of care; and increases patient satisfaction, all critical measures for health systems and payers alike, according to the CAPC.

Payers and healthcare executives alike are taking note.

Speaking recently at the CAPC’s National Seminar, American Hospital Association Chief Medical Officer Jay Bhatt said, “High quality, cross-continuum palliative care services are a critical part of the solution for health systems as they make the transformation toward value.”

In 2019, Medicare Advantage Programs will launch a new palliative care initiative centered on meeting patients at the time of diagnosis for open discussion about their personal needs, hopes and fears and, most importantly, the direction they want their care to take.

“We know the question isn’t, ‘How do you want to die?’ It is, ‘How do you want to live?’ This is the patient-directed focus we’ve been advocating for at Crossroads for many years,” said President and CEO Perry Farmer.

Expanding palliative care programs – and ensuring access to them – is key to healthcare transformation.

“Hospice and palliative care providers like Crossroads are uniquely qualified and positioned to expand and serve our aging population by furthering our philosophy of care to patients, caregivers, and institutions,” Farmer said. “If they model our approach, they will increase patient satisfaction, increase the overall quality of care and reduce expenditures. I believe that achieving that critical triple aim can change a nation and save the world.”

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