More hospitals start palliative care programs

Comprehensive quality-of-life programs for seriously ill patients are growing despite financial hurdles.

By Kevin B. O’Reilly — Posted Nov. 3, 2008

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The proportion of hospitals with palliative care programs has more than doubled since 2000 to 53% of all facilities with more than 50 beds, according to a study in the October Journal of Palliative Medicine.

But the prevalence of hospital-based palliative care varies widely by state, and about 310,000 seriously ill patients a year lack access to such specialized care, said R. Sean Morrison, MD, co-author of the study and an accompanying state-by-state report card.

Only three states -- Vermont, Montana and New Hampshire -- got an "A" for having palliative care programs in more than 80% of hospitals. Fifteen states fell below the 50% prevalence mark.

"What's encouraging for me is that 53% of hospitals are reporting programs, and patients have access to them," said Dr. Morrison, director of the National Palliative Care Research Center. "What's distressing is that 47% of hospitals don't have these programs."

Palliative care programs provide comprehensive care for the physical, psychological, social and spiritual challenges that seriously ill patients and their families face. While hospice care is reserved for patients with fewer than six months to live, palliative care can be offered to patients as soon as they are diagnosed with life-threatening illnesses.

The first exam recognized by the American Board of Medical Specialties for certification in hospice and palliative medicine is set for Oct. 29. About 2,500 physicians identify themselves as palliative care specialists. Experts estimate that 10,000 will be needed to meet the demands of baby boomers.

"The reason why we've seen palliative care grow so dramatically and why you've seen how quickly it became an ABMS specialty is that everybody recognizes the need for it," said Dr. Morrison, professor of palliative care at Mount Sinai School of Medicine in New York. "As we've transitioned what used to be fatal diseases -- heart failure, cancer, lung failure -- into chronic diseases, we have not kept up the quality of life patients should expect to have in living with those diseases."

The American Medical Association strongly supports palliative medicine training and education and appropriate reimbursement for such care.

Previous research has shown that palliative care programs can cut unwanted aggressive care, help patients and families cope with serious illnesses, and improve satisfaction with care. A Sept. 8 Archives of Internal Medicine study found that palliative care programs save the typical 300-bed hospital $1.3 million in annual direct costs by skipping aggressive care patients don't want.

Increasing funds for training

The report card, produced by the Center to Advance Palliative Care and the National Palliative Care Research Center, calls on states to increase funding for palliative care training and make Medicaid reimbursement to hospitals contingent on implementing palliative care programs.

The report card lauded New York -- which got a "C" -- for approving $4.6 million for palliative care education and training in June. California, another "C" performer, was cited as a model for requiring all physicians to complete continuing medical education on "pain management and the treatment of terminally ill and dying patients."

Palliative care experts welcomed the report.

"The approach of using report cards has been done successfully" in other areas, said Russell K. Portenoy, MD, president of the American Academy of Hospice and Palliative Medicine. The new study "reports data that could potentially drive public policy, and without changes in public policy -- for example, in health care financing -- it will be very difficult to grow and sustain palliative care in institutional environments."

The American Hospital Assn. did not respond to a request for comment on whether states should require palliative care programs. The group's Circle of Life Award honors outstanding hospital palliative care services.

Although Medicare reimburses doctors for palliative care evaluation and management, many other parts of the team go unreimbursed, meaning hospitals must make an up-front investment in the services in hopes of creating longer-term savings.

James A. Tulsky, MD, said the reported progress is just a start.

"The goal should be that every hospital and health care system have palliative care integrated into their system," said Dr. Tulsky, director of the Center for Palliative Care and professor of medicine and nursing at Duke University in North Carolina. "It's an integral part of the care they deliver to patients with serious illnesses."

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Grading palliative care

More than half of U.S. hospitals with 50 or more beds operate palliative care programs. But the prevalence of these services varies significantly.

A - Programs in 81% to 100% of hospitals Vermont (100%), Montana (88%), New Hampshire (85%)

B - Programs in 61% to 80% of hospitals District of Columbia (80%), South Dakota (78%), Minnesota (75%), Missouri (73%), New Jersey (72%), Oregon (72%), Iowa (70%), Maine (69%), Michigan (69%), North Carolina (69%), Ohio (68%), Colorado (67%), Maryland (67%), North Dakota (67%), West Virginia (67%), Washington (65%), Wisconsin (64%), Virginia (63%), Kansas (61%)

C - Programs in 41% to 60% of hospitals Alaska (60%), Delaware (60%), Rhode Island (60%), Illinois (58%), New York (58%), California (56%), Idaho (56%), Nebraska (56%), Utah (56%), Connecticut (54%), Indiana (54%), Pennsylvania (54%), Arizona (50%), Massachusetts (50%), Florida (49%), Hawaii (45%), Tennessee (45%), Arkansas (41%)

D - Programs in 21% to 40% of hospitals Georgia (38%), Kentucky (37%), New Mexico (33%), Texas (33%), South Carolina (30%), Louisiana (27%), Wyoming (25%), Nevada (23%)

F - Programs in 0% to 20% of hospitals Oklahoma (19%), Alabama (16%), Mississippi (10%)

Source: "America's Care of Serious Illness: A State-by-State Report Card on Access to Palliative Care in Our Nation's Hospitals," Center to Advance Palliative Care and National Palliative Care Research Center, September

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External links

"America's Care of Serious Illness: A State-by-State Report Card on Access to Palliative Care in Our Nation's Hospitals," Center to Advance Palliative Care and National Palliative Care Research Center, September (link)

National Palliative Care Research Center (link)

American Academy of Hospice and Palliative Medicine (link)

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