Column: End-of-Life Investment

Palliative care helps patients and reduces healthcare costs

Diversity has always been one of our country's strengths. But for all our differences, we all tend to value the same things: health, a good job, our children's happiness and, somewhere down the list, the hope of confronting end-of-life issues with dignity.  

As the hospice movement has bloomed over the last 35 years, one might say there have been more peaceful deaths. More than ever, issues surrounding death have become part of the national dialogue. Going forward, however, we face enormous challenges. As a nation, our unfunded Medicare liabilities project into the trillions of dollars. We spend a disproportionate amount of our healthcare dollars in the last year of life, too often with little benefit and untreated suffering. Plus, an aging baby boomer demographic threatens to put massive stress on an already-overburdened healthcare system.  

Research indicates that many patients would choose comfort-based care if they know their time is limited. Unfortunately, doctors and patients rarely discuss these issues and many patients spend their final months cycling through the emergency room and intensive care units (ICU). 

The reasons are myriad. Doctors often associate stopping aggressive care with failure. Decision-making conversations can be time intensive and complicated, and without guidance, patients and families often confuse high-tech care with optimal care.  

Imagine a team of specially trained physicians, social workers and nurses who could work with patients and their doctors to navigate this complexity. They would be experts in symptom management and communication, helping achieve an outcome our health system urgently needs: reduced costs and increased patient satisfaction.

Such "palliative" care teams do exist in a growing number of hospitals nationwide, including the Mayo Clinic and the Cleveland Clinic. While palliative care can be considered the philosophy behind hospice, it does not have to be end-of-life care. In fact, the ideal time for palliative care involvement is soon after diagnosis in order to treat symptoms and start the complex conversations required when one has a life-limiting illness. 

The development of palliative care services is at the core of what our healthcare system needs: a radical realignment of resources and outcomes. And while the research is still evolving, there is tantalizing evidence that these interventions are long-term investments, with the upfront costs of supporting a palliative team paying off in terms of cost savings and patient satisfaction. 

It's clear that healthcare reimbursement in the future will not mimic the past. We simply cannot afford doing things the old way. Quality of care rather than quantity of care will be rewarded. Too many infections in your ICU? Your reimbursement goes down. Preventable readmissions for the same diagnosis? Maybe you do not get paid at all. Progressive health systems recognize these changes and are planning accordingly. It's no surprise that such systems were highlighted in the recent healthcare debate.   

If we are to give our elders the care choices they deserve, we must invest now in programs that make better use of our resources. Palliative care can be an important part of this plan.

Dr. William Kennedy is Hospice co-medical director for Adventist Health Home Care Services, which cares for Southwest Washington and Oregon residents. He can be reached at 503.251.6192.

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