Palliative care: Putting power in the hands of patients

When it comes to advance care planning, patients should be in charge of what they want in terms of quality of life and treatment. Palliative care is beginning to transform the health care environment by promoting a holistic, patient-focused model with the potential to drastically lower industry costs.

Also known as comfort care, palliative care helps relieve symptoms associated with a chronic illness, such as cancer, cardiac disease or Alzheimer’s. Palliative care teams—which may include specially trained physicians, nurses, social workers and others—provide an extra layer of care for people facing serious health issues. The ultimate goal is to surround patients and their families with resources needed to assist with decision-making, and keep patients home and out of the hospital, while maintaining quality of life.

“Palliative care puts the power back into the hands of patients and allows them to be in control of their treatments,” said Craig Borchardt, PhD, assistant professor in the Department of Humanities in Medicine at the Texas A&M Health Science Center College of Medicine and president and CEO of Hospice Brazos Valley. “Palliative care seeks to slow the pace of the decision making process, giving patients time to think through treatment options related to chronic illness.”

In 2014, the Institute of Medicine called for a major reform to end-of-life care and the effects are already being seen. Thanks to a new Medicare rule that takes effect in January, physicians and other qualified health care professionals will now be reimbursed to discuss end-of-life wishes with Medicare patients. “This is an important development for advance-care planning,” Borchardt said. “It has the potential to prompt more physicians to engage patients in these discussions about their preferences much earlier in the disease process, perhaps before an illness progresses to a terminal diagnosis.”

Statistics show some 28 percent of Medicare dollars—an annual $170 billion—are spent during a patient’s last six months of life, often on futile treatments that lead to suffering. Borchardt believes palliative care teams will aid in eliminating repetitive emergency room visits and hospital stays—a significant reason why medical costs are skyrocketing. If palliative care were fully penetrated into the nation’s hospitals, total savings could amount to $6 billion per year.

“If a patient has a crisis at home, the palliative care team will be called instead of rushing the patient to the hospital,” Borchardt said. “As we move toward providing care in the home, this will lower insurance payments and reduce hospital stays.”

“The palliative care model will be integral as health care moves toward getting people out of the hospital faster,” he added. “If we can focus on providing quality care outside of these settings it will be much more cost-effective for both the patient and insurer.”

Worth noting, Borchardt believes in the current health care arena, insurance companies will be looking to maximize reimbursements and cut their costs. “Palliative care will be looked at heavily because of the potential savings,” he said.

According to Borchardt, palliative care could also provide an extension of care for physicians and lower the amount of time patients spend in the doctor’s office. “Palliative care teams can provide an extra set of eyes and ears for physicians and assist in the development of care plans to reduce patient visits to primary care offices. This allows patient-care to be more focused without necessarily having to be in a doctor’s office all the time,” he said.

As the health care arena continues to change, palliative care has the unique opportunity to enrich communication channels in the medical field. “Palliative care will build teamwork in health care and break down the silos we practice in,” Borchardt said. “The system at times is dysfunctional because physicians often don’t communicate with each other. Palliative care can bridge these gaps between physicians and their patients.” While it’s an attractive option for health care reform, many worry about the specialty’s future.

There is already a national shortage of palliative care physicians (between 8,000 to 10,000) and demand will likely grow as the number of Americans 65 and older increases (projected to reach 88.5 million in 2050, according to the Department of Health and Human Services’ Administration on Aging) and the number of people living with chronic conditions continues to climb.

“A growing body of medical research documents the benefits of palliative care—for patients, families, hospitals, payers and the health care system as a whole—but we must have a sufficient number of health care professionals trained to provide such care,” Borchardt said.

That’s why many medical schools, including the Texas A&M College of Medicine, are including palliative and hospice care within their curriculum.

“Our students are taught hospice and palliative medicine in a variety of ways,” Borchardt said. “Years one and two consist of lectures and exercises with simulated patients in the Clinical Learning Resource Center (a simulated learning hospital), in which students must break bad news to simulated patients facing death.

“In the third year, students round with hospice and palliative physicians, visit patients in their homes—including nursing homes and assisted living facilities—and fourth years may take an elective in palliative medicine where they complete a two-week palliative and hospice rotation as a member of a palliative care team.”

Borchardt believes palliative-care training is crucial for medical school graduates. “Integrating palliative medicine into the medical school curriculum provides an early opportunity for future physicians to grasp the concept of patient-centered medicine, as well as the understanding that the role of being a physician is to take care of the patient,” he said. “Sometimes that means curing the patient; when a cure is not possible, it means healing the patient through palliative care.”

“Palliative care has the ability to cut costs and help patients have better access to all their resources,” Borchardt said. “It has become a vehicle to help patients access all the medical resources at their disposal, while proving beneficial for all parties involved. I think we’ll begin seeing palliative care integrated into routine care more and more.”