Center for Improving Value in Health Care
Jun 5, 2012 | 2 comments | Posted by Jenny Nate
Delivery System Redesign, End-of-Life Care, Palliative Care, Coordinated Care
Despite some interesting “discussions” at the federal level on end-of-life care over the last few years, CIVHC continues our commitment as a convener and leader to improve access to high-quality palliative care across Colorado. Along the way, we’ve received many questions from stakeholders about palliative care and our decision to focus on this topic, especially in the light of highly charged political rhetoric associated with end-of-life care over the last couple years. Over the course of the next few months, I will be answering some of the questions we get most often in an effort to demystify palliative care. Today's question focuses on a common misperception that palliative care and hospice care are one and the same.
What's The Difference Between Palliative Care and Hospice Care?
I often hear people use “hospice care” and “palliative care” interchangeably, but there are some important distinctions between these terms. “Hospice care” is a very specific term to describe a package of services most popularly defined by Medicare’s hospice benefit. Hospice care is a type of palliative care that is provided anywhere in the home or community where a patient resides. A hospice care team usually includes a doctor and nurses, social workers, spiritual advisors, nursing assistants, and trained volunteers. This team provides a range of services including basic medical care with a focus on pain and symptom control, medical supplies and equipment, counseling and social support to help you and your family with psychological, emotional, and spiritual issues. In order to be financially eligible for hospice care, the patient must agree to discontinue curative treatment, and a doctor signs a form to indicate that the patient’s life expectancy is six months or less. Usually this form requires signatures by the patient’s primary care provider as well as the medical director or physician member of a hospice team.
Palliative care is a broader approach to care that is appropriate at any stage of a serious illness, whether that illness is potentially curable, chronic or life-threatening. Palliative care is appropriate for a much broader group of patients than hospice and, unlike hospice, may be provided in conjunction with curative or life-prolonging treatment. The following is an example of what a palliative care scenario might look like from a Modern Healthcare article entitled "Hospitals Add Palliative Teams at Rapid Rate".
“A patient is diagnosed with lung cancer, and a palliative care team's assistance is enlisted from the start, working alongside oncologists and other specialists. The palliative team may include doctors and nurses as well as a social worker and chaplain. Together, they coordinate care among the many medical professionals, have long consults with the patients and their families to answer questions, and may preventively prescribe medications for likely side effects of treatment, from pain to constipation to nausea.
The palliative team has a clear vision of the patients' goals and personal philosophies and, depending on these factors, might help steer them away from treatments that are determined to be more painful than they're worth. Though palliative doctors share some similarities with hospice doctors in this regard, their goal is still to cure, and their patients are not considered to be at the end of their lives, they are simply facing a serious illness.”
Another important distinction between hospice care and palliative care is that although palliative care is provided in several hospitals and communities across the United States, there is no reimbursement model for palliative care outside the specific hospice benefit. This creates a major barrier for patients who would greatly benefit from palliative care from gaining access to these services. Many hospitals here in Colorado have established palliative care programs despite the lack of reimbursement because of the growing body of evidence that palliative care services have a tremendous impact on the quality of care for the patients as well as the cost savings of this type of intervention. We’ll talk more specifically about palliative care’s impact on health care quality, patient satisfaction, and cost efficiency is the coming months.
Learn more about CIVHC's Palliative Care Initiative.
Read Part II, "Why Focus on Palliative Care?" and Part III, "What is CIVHC Doing to Address Palliative Care?" in the series. Contact the author at email@example.com.
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