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Coloradans with Serious Illnesses Lack Essential Care Services

CONTACT: Cari Frank, Director of Communications
CIVHC | Center for Improving Value in Health Care

May 29, 2015 – DENVER – A new study analyzing trends in care provided to Coloradans with serious illnesses identifies significant gaps in care available across the state. While some hospitals and hospices have expanded services, lack of payment for team-based care for patients and families remains a major barrier.

A common misconception among the general public and even among some health care providers is the notion that palliative care is synonymous with hospice or end of life care. On the contrary, according to the definition established by the Colorado Standards for Hospitals and Health Facilities, palliative care is “specialized medical care for people with serious illnesses” – regardless of age, diagnosis or likelihood of recovery.

Patients and families experiencing a serious illness such as cancer or Chronic Obstructive Pulmonary Disease (COPD) often find navigating the health care system to be frustrating, inefficient and ineffective in meeting their needs and wishes. Lack of care coordination during this fragile period of time can also result in poor quality of life and more expensive or undesired treatments, driving up costs without a direct benefit to the patient or family.

Effective palliative care provides patients with coordinated care to relieve them of the stress, pain and symptoms related to their illness. These services are most effective when provided by a team of providers including physicians, nurses, social workers, and other care providers.

According to a new study released the Center for Improving Value in Health Care (CIVHC), more palliative care services are now being provided by Colorado hospitals and hospice centers compared to an original study conducted in 2008. However, palliative care services are not being offered to the extent they could across the state and are significantly lacking in some rural areas.

Facilities surveyed identified lack of reimbursement by health insurers as one of the major barriers to providing more extensive palliative care services. Cultural misconceptions over what palliative care services are for were also noted as a barrier in the study.

“It can be difficult for providers to talk to their patients about palliative care services because of the lack of understanding about what it truly means,” explains Kristin Paulson, JD, MPH, Director of Health Care Programs for CIVHC and lead author of the newly released study. “In addition to the cultural issues, only physicians and in some cases nurses are able to bill insurance for these important services which is another major barrier to providing effective team-based care Coloradans with serious illnesses.”

Paulson notes that while the survey results show a substantial increase in the number of palliative care consults being provided at hospitals and hospices compared to 2008, CIVHC is aware of several facilities that have actually shut down palliative care services since the 2013 study was conducted because of lack of adequate reimbursement.

“Providing extensive, team-based care is expensive and most hospitals and hospice centers have to provide the majority of services in-kind. For many facilities, especially those in rural areas with very limited resources, it’s often just simply unaffordable.”

Key insights from the report include:

  • Hospitals continue to be the primary source of palliative care across the state
  • Hospital-based palliative care consults increased by more than 400 percent from 2008-2013
  • Hospice-based palliative care consults increased by more than 200 percent from 2008-2013
  • Reimbursement continues to be a concern and creates a substantial barrier to expanded service from all providers
  • Access to palliative care is disproportionately centered in the metro Denver area, leaving more rural residents without a source of care

Efforts are underway to demonstrate the effectiveness of palliative care on patient and family quality of life and clinical outcomes, as well as the decrease in overall health costs.

“Expanding palliative care across the state has the potential to positively impact lives and lower health care costs, and CIVHC is committed to help make it happen,” shares Ana English, CIVHC’s President and CEO. “We’re currently working on an analysis based on information from the Colorado All Payer Claims Database to identify cost savings generated from providing palliative care services.” This information can then be used to demonstrate a return on investment to health insurance payers to encourage reimbursement for palliative care.

The report also notes that recent federal funding opportunities to advance the science of palliative care may indicate a change in cultural priorities and may spur an increased awareness of the benefits of palliative care.

Download the full report.

About CIVHC. The Center for Improving Value in Health Care is a nonprofit, nonpartisan organization that helps Colorado drive, deliver and buy value in health care. Through the pioneering Colorado All Payer Claims Database, we offer the state’s most comprehensive health care cost, quality and utilization claims data. We unlock information and insights that guide meaningful action to improve health, enhance quality and lower cost. Bringing together a broad spectrum of organizations and individuals to design and drive collective change, CIVHC is devoted to a single cause: advancing an exceptional health care system for Colorado.