If palliative care were a drug, patients would be clamoring for it, providers would rely on it and more medical school graduates would be specializing in it. Palliative care has been proven to lower hospital readmission rates and healthcare costs, improve patient experience and outcomes and help people live longer. It gives patients more voice in their care and develops transparency and candor in the patient/provider relationship. There are drugs that don’t do half as much and are easily approved and wildly popular.
So why are so many seriously ill patients suffering needlessly without the benefit of palliative care?
Our healthcare system operates under the misconception that patients aren’t ready for palliative care until they are in the process of dying. Yet palliative care is designed for patients at any age or stage in their illness to treat the symptoms that cause suffering, whether physical, emotional or spiritual. Too few primary care providers, oncologists and other specialists have been exposed to its benefits in a meaningful way that challenges their preconceived notions of what it can do. Even those who believe that palliative care is the right thing for patients with advanced illnesses may have no sense of when to refer their patients to palliative medicine physicians.
As an industry, we need to better communicate the value of palliative care to both providers and patients. If they don’t know what it is, they’re not going to ask for it. To build a system where palliative care is an essential part of the continuum of care, we also need to deal with the factors that make the American healthcare system so fragmented.
All providers need a single source of data that gives them a full picture of their patient’s medical journey. Private practices and healthcare organizations need to invest in programs that identify which patients are at the highest risk for utilizing non-beneficial treatment and then connect the multidisciplinary care community to collaborate and act on appropriate care plans for those patients. To that end, the Centers for Medicare and Medicaid Services (CMS) has been piloting programs that provide Medicare/Medicaid medical and medication claims data for all patients in their system, including Blue Button and Data at the Point of Care. Blue Button delivers data directly to beneficiaries. Data at the Point of Care is being tested on fee-for-service providers who treat Medicare patients.
Using CMS’s structured data, providers would no longer have to rely on patients’ memories or other providers’ records to view a new patient’s medical history or know what other providers treat their current patients. By aggregating CMS data with a practice’s EHR data — something that technology platforms can currently do — every provider can have a 360-degree view of each patient’s condition and a better sense of when they would benefit from palliative care.
The demand for palliative care will increase when providers understand what it is and when to refer patients. However, providers also need specialists to refer to. Currently, there are only 4,400 hospice and palliative medicine physicians in the United States — or 1 for every 20,000 older adults with a life-threatening illness. That is clearly not enough. Reimbursement is less lucrative for this field of medicine, which is a huge disincentive for medical school graduates, who often select a specialty based on how quickly they’ll be able to pay off their student loans. Additionally, palliative care providers currently have to cross a number of thresholds to bill for home visits, creating another disincentive to offer home-based care.
It’s time for healthcare systems and payer sources to understand that palliative care is an essential service that needs to be included in the continuum of care. It’s a service they need to subsidize for the good of their patients and the good of their system. They need to invest in technology that gives them the data they need to connect everyone across the care continuum, lower utilization and healthcare spending, and improve outcomes for America’s sickest and most costly patients. To make it available to the growing number of patients who will benefit from it, our healthcare systems need to hire nurses, nurse practitioners and palliative care medicine physicians to do this work at a wage that is competitive with other specialties.
We can transform the management of advanced illness, but it takes a collective effort to move the healthcare industry forward with compassion and a commitment to change. Around 10,000 people a day turn 65 in the U.S., a figure expected to double over the next few decades. The time to commit is now.
Jeremy Powell is founder and chief executive officer of Acclivity Health.
Amer Alnajar, M.D., is co-founder and chief medical officer of Vytalize Health.