Financial Considerations Of Hospital Based Palliative Care

Palliative care is an interdisciplinary care philosophy addressing patient and family needs and goals without providing a cure for the underlying disease. Palliative care can be successfully provided alongside curative care, which does focus on treating the disease. Studies have indicated that palliative care offers a variety of quality of life benefits to both the patient and family. Prompted by rapid growth of hospital-based palliative care, we explored the literature to better understand the financial incentives and barriers to these programs. Although patients who receive palliative care in the hospital have lower hospital costs than matched patients who do not receive palliative care, many hospitals face challenges in being reimbursed for services rendered by their interdisciplinary teams. In some cases, hospitals may absorb 50 percent of the costs of their palliative care teams because of lack of adequate reimbursement. Despite the opportunity for cost savings for a variety of stakeholders, without payment reform hospitals may be constrained from providing palliative care to all who might benefit. Additional research is needed to understand how patients, hospitals, and payers may participate in cost savings attributable to palliative care so that policymakers can effectively promote these services.

Palliative care is an interdisciplinary care philosophy addressing patient and family needs and goals without providing a cure for the underlying disease. Palliative care can be successfully provided alongside curative care, which does focus on treating the disease. Studies have indicated that palliative care offers a variety of quality of life benefits to both the patient and family. Prompted by rapid growth of hospital-based palliative care, we explored the literature to better understand the financial incentives and barriers to these programs. Although patients who receive palliative care in the hospital have lower hospital costs than matched patients who do not receive palliative care, many hospitals face challenges in being reimbursed for services rendered by their interdisciplinary teams. In some cases, hospitals may absorb 50 percent of the costs of their palliative care teams because of lack of adequate reimbursement. Despite the opportunity for cost savings for a variety of stakeholders, without payment reform hospitals may be constrained from providing palliative care to all who might benefit. Additional research is needed to understand how patients, hospitals, and payers may participate in cost savings attributable to palliative care so that policymakers can effectively promote these services.

For patients and their loved ones, no care decisions are more profound than those made near the end of life. Unfortunately, the experience of dying in the United States is often characterized by fragmented care, inadequate treatment of distressing symptoms, frequent transitions among care settings, and enormous care responsibilities for families. According to this report, the current health care system of rendering more intensive services than are necessary and desired by patients, and the lack of coordination among programs increases risks to patients and creates avoidable burdens on them and their families. Dying in America is a study of the current state of health care for persons of all ages who are nearing the end of life. Death is not a strictly medical event. Ideally, health care for those nearing the end of life harmonizes with social, psychological, and spiritual support. All people with advanced illnesses who may be approaching the end of life are entitled to access to high-quality, compassionate, evidence-based care, consistent with their wishes. Dying in America evaluates strategies to integrate care into a person- and family-centered, team-based framework, and makes recommendations to create a system that coordinates care and supports and respects the choices of patients and their families. The findings and recommendations of this report will address the needs of patients and their families and assist policy makers, clinicians and their educational and credentialing bodies, leaders of health care delivery and financing organizations, researchers, public and private funders, religious and community leaders, advocates of better care, journalists, and the public to provide the best care possible for people nearing the end of life.

When the end of life makes its inevitable appearance, people should be able to expect reliable, humane, and effective caregiving. Yet too many dying people suffer unnecessarily. While an "overtreated" dying is feared, untreated pain or emotional abandonment are equally frightening. Approaching Death reflects a wide-ranging effort to understand what we know about care at the end of life, what we have yet to learn, and what we know but do not adequately apply. It seeks to build understanding of what constitutes good care for the dying and offers recommendations to decisionmakers that address specific barriers to achieving good care. This volume offers a profile of when, where, and how Americans die. It examines the dimensions of caring at the end of life: Determining diagnosis and prognosis and communicating these to patient and family. Establishing clinical and personal goals. Matching physical, psychological, spiritual, and practical care strategies to the patient's values and circumstances. Approaching Death considers the dying experience in hospitals, nursing homes, and other settings and the role of interdisciplinary teams and managed care. It offers perspectives on quality measurement and improvement, the role of practice guidelines, cost concerns, and legal issues such as assisted suicide. The book proposes how health professionals can become better prepared to care well for those who are dying and to understand that these are not patients for whom "nothing can be done."

The first comprehensive, clinically focused guide to help hospitalists and other hospital-based clinicians provide quality palliative care in the inpatient setting. Written for practicing clinicians by a team of experts in the field of palliative care and hospital care, Hospital-Based Palliative Medicine: A Practical, Evidence-Based Approach offers: Comprehensive content over three domains of inpatient palliative care: symptom management, communication and decision making, and practical skills, Detailed information on assessment and management of symptoms commonly experienced by seriously ill patients, Advise on the use of specific communication techniques to address sensitive topics such as prognosis, goals of care, code status, advance care planning, and family meetings in a patient- and family-centered manner, Targeted content for specific scenarios, including palliative care emergencies, care at the end of life, and an overview of post-hospital palliative care options, Self-care strategies for resilience and clinician wellness which can be used to help maintain an empathic, engaged, workforce and high quality patient care, A consistent chapter format with highlighted clinical pearls and pitfalls, ensuring the material is easily accessible to the busy hospitalist and associated hospital staff. This title will be of use to all hospital clinicians who care for seriously ill patients and their families. Specialist-trained palliative care clinicians will also find this title useful by outlining a framework for the delivery of palliative care by the patient’s front-line hospital providers. Also available in the in the Hospital-Based Medicine: Current Concepts series: Inpatient Anticoagulation Margaret C. Fang, Editor, 2011 Hospital Images: A Clinical Atlas Paul B. Aronowitz, Editor, 2012 Becoming a Consummate Clinician: What Every Student, House Officer, and Hospital Practitioner Needs to Know Ary L. Goldberger and Zachary D. Goldberger, Editors, 2012 Perioperative Medicine: Medical Consultation and Co-Management Amir K. Jaffer and Paul J. Grant, Editors, 2012 Clinical Care Conundrums: Challenging Diagnoses in Hospital Medicine James C. Pile, Thomas E. Baudendistel, and Brian J. Harte, Editors, 2013 Inpatient Cardiovascular Medicine Brahmajee K. Nallamothu and Timir S. Baman, Editors 2013

Once defiant of death—or even in denial—many American families and health care professionals are embracing the notion that a life consumed by suffering may not be worth living. Sociologist Roi Livne documents the rise and effectiveness of hospice and palliative care, and the growing acceptance that less treatment may be better near the end of life.

This new edition provides the essential clinical guidance both for those embarking upon a career in palliative medicine and for those already established in the field. A team of international experts here distil what every practitioner needs to know into a practical and reliable resource.

When the first edition of this book (Terminal Care Support Teams: the hospital-hospice interface, 1990) was written, there were only a few advisory palliative care teams working in hospitals. Since then the number of teams has grown rapidly. The concept of these teams in now widely accepted but there is an increased need for information about setting up a team, how they work and how effective they are. This book looks at the need for hospital- based palliative care teams and the challenges of bringing palliative care into the acute hospital setting. It reviews the needs of patients, their families and their professional carers, and also looks at the theoretical and practical problems which may be encountered. For example there is practical advice on setting up hospital-based palliative care teams, the selection of team members as well as coverage of team dynamics, and the role of the pain clinic and palliation oncology.