In order to be successful, Accountable Care Organizations must adapt cost cutting strategies that prove effective in the short and long term and complement long term population health management. Adding palliative care teams (physicians, nursing, therapists, pharmacies, hospice, and long term care facilities) to services even while aggressive life extending measures are on the rise, brings the right mix of services to the growing aging population.
Today there is 1 palliative care physician for every 1300 patients and an estimated physician shortage of 18,000 would seem to thwart the efforts to expand palliative care.
More patients are dying at home than in the hospital, in accordance with their wishes, while the use of hospice and hospital palliative care services grows. Despite embracing hospice care, more people are using hospice for only three days or less. What’s more, nearly one-third of those short hospice stays followed a hospitalization and ICU stay in the last month of life. Such findings indicate that increased hospice use may not mean lower healthcare resource utilization.
Palliative care programs lead to lower patient costs. For example, at Kaiser Permanente, average costs for palliative care patients with cancer were 35 percent lower than for usual-care patients, 67 percent lower for palliative care patients with chronic obstructive pulmonary disease and 52 percent lower for palliative care patients with congestive heart failure.
So the question is why the disconnect? Research seems to indicate a lack of communication coordination between patients, family, and providers about options for end of life care. While people say they are interested in palliative care, they do not really talk about it to the right people.
Your practice is the “right people,” allowing patients options and taking the time to explain the pros and cons of options is a great way to get people actively involved in their own end of life decisions. And those conversations need to take place long before they have to implement them. The average patient will respond favorably to these conversations. Everyone has had some end of life experiences with friends/relatives/acquaintances and probably have already formed an opinion about how they would proceed. However, odds are, no one has asked them what they think.
Developing a practice strategy to address this critical issue with patients will accomplish multiple goals in 2015. It will help patients, promote palliative care, reduce cost, open up new jobs in healthcare and, most importantly, give end of life care the dignity it deserves.