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Now is the time for a radical shift in the way we think about the continuum of care.
Now is the time for a radical shift in the way we think about the continuum of care.

Don't deny the economics

Hospice and palliative care are best for chronic illness, controlling costs

By Sally Adelus
Posted: July 21, 2012 - 12:01 am ET

While change has been an ever-present force in our nation's healthcare system, what we are seeing now is a monumental transformation in the way care will be provided in the future. It's an issue that is being discussed far and wide, from conversations around the dinner table to election-year speeches of candidates and even among the justices on the U.S. Supreme Court.

The essence of healthcare reform, often dubbed Obamacare, can be broken down into three broad areas—expanding coverage, controlling costs and improving the delivery of care. One aspect of our healthcare system that has been under the proverbial microscope is the management of patients with chronic illnesses. Included in health reform legislation are proposed penalties for hospitals that readmit patients with certain chronic conditions within 30 days.

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Regardless of the decisions, significant change must happen in the way we care for patients with chronic conditions to best meet their needs and support their caregivers. Statistics from the Dartmouth Atlas of Health Care illustrate the need. Approximately 90 million Americans live with at least one chronic disease. In New York City, the average person with a serious illness receives care from 12 specialists, with no one coordinating care.

To better manage patients with chronic conditions and reduce multiple hospitalizations and unnecessary visits to the ER, we must elevate hospice and palliative care within the overall continuum of care. Along with expertise in pain and symptom management for the patient and emotional and spiritual support for the entire family, there is so much more to hospice and palliative care. Hallmarks of hospice and palliative care include assistance navigating our complex healthcare system, help identifying resources in the community, guidance on treatment choices and care coordination. The doctors, nurses and other specialists who compose the team work with a patient's other doctors to provide an extra layer of support.

As it stands now, our healthcare system embraces a different perspective. Dr. Ira Byock, director of palliative medicine at Dartmouth-Hitchcock Medical Center in Lebanon, N.H., and professor of anesthesiology and community and family medicine at Dartmouth Medical School, said, “We have a disease-treatment system rather than a healthcare system caring for human beings.”

Our healthcare system views hospice as if it's a separate entity, not an important part of the care continuum. The phenomenal advances in medical technology, treatments and medications help patients of all ages fight against heart and vascular conditions, cancers and an array of debilitating conditions. When one treatment fails, we try the next option and then the next. This process continues until there are no other options. It's at this point that patients may come to hospice. More often than not, patients are referred too late and are not given the chance to receive the full range of benefits hospice provides. In 2010, more than one- third of patients referred to hospice care died within seven days of admission.

Palliative care, which can be provided while a patient seeks curative treatment, rarely is introduced by physicians or other members of a patient's healthcare team. Research has shown that some physicians equate palliative care with end-of-life care. As a result, patients don't know the types of comfort care and support they could receive to enhance their quality of life while they seek to cure their illness. If the decision is made to forgo curative care, patients can transition to hospice care to receive support, based on their goals, to enhance quality of life.

Sally Adelus, president and CEO of Hospice of the Valley, San Jose, Calif.
Sally Adelus is president and CEO of Hospice of the Valley, San Jose, Calif.
Aside from the obvious benefit of providing care and support from a team of healthcare professionals dedicated to pain and symptom control and emotional and spiritual support, you can't deny the economics. A study conducted by Duke University found that “hospice reduced Medicare spending by an average of $2,309 per person compared to normal care that often includes hospitalization.” In addition, the study found that longer use of hospice—months versus days or even weeks—maximized savings to Medicare.

Healthcare expenses are reduced because of the manner in which hospice care is delivered, often provided where the patient lives, whether that is a private residence, assisted- living facility or nursing home. Nurses are available 24 hours a day to answer questions and coordinate care should a patient's condition change, which reduces the need for visits to an emergency room. Study after study has shown the majority of Americans want to receive end-of-life care at home. Yet, according to the Centers for Disease Control and Prevention, nearly half of all Americans die in a hospital.

Hospice and palliative care are proven models to manage costs of care most efficiently during a serious illness and at end of life. This is the time for a radical shift in the way we think about the continuum of care. Rather than hospice and palliative care being considered options when “nothing more can be done,” these specialized areas of care and support must be better integrated throughout the care continuum. Doing so will better meet patients' needs, reduce the multiple hospitalizations and unnecessary visits to the emergency room, and thus control costs of healthcare.

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