Palliative Care Gains Favor as It Lowers Costs

[question everything]

Insurers are establishing programs that give the sickest patients the chance to receive extra care for their pain, suffering and emotional needs, in a move that turns out to cut spending substantially. Such palliative-care programs aim to provide assistance to patients with chronic or terminal illnesses, and go beyond the drug prescriptions and surgeries such patients typically receive. Under the programs, doctors are often called in to prescribe drugs treating pain, anxiety and depression, while home-care aides visit residences to give baths and change sheets. Social workers may try to resolve conflicts between estranged siblings.

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Studies show that treatment of the most complex patients during their final months accounts for a disproportionate amount of health-care spending. About 25% of Medicare costs cover the last year of patients' lives, while 80% of the government health program's spending during the last month is for hospitalization. A visit to an intensive-care unit alone can cost more than $4,000 a day. Evidence suggests that the palliative-care programs can make a major dent in those costs. Studies by Kaiser Permanente, for instance, found that such programs can save $5,000 to $7,000 a patient by preventing costly trips to emergency rooms and avoidable readmissions to hospitals.

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Typical candidates for palliative care include patients suffering from congestive heart failure, chronic obstructive pulmonary disease and dementia. Many participants have cancer, typically at an advanced stage. Dedicated teams of doctors, nurses, chaplains and social workers step in to interview the patients to assess their needs and develop a plan for their extra care. Often team members sit in on meetings between patients and their doctors, help explain medical conditions, and help the patients and families reach decisions about the course of treatment. A palliative-care team might also help coordinate a patient's treatment among different doctors.

Many programs offer help drawing up wills and do-not-resuscitate orders. Such orders let doctors and nurses know the patient wants to forgo cardiopulmonary resuscitation, being put on a ventilator and other measures if there is a low chance for recovery. Sometimes, the patients get care in hospices or from visiting hospice nurses for their pain, suffering and emotional needs but give up aggressive medical treatment.

During the 2009-10 health-care-overhaul debate, a proposal to pay doctors for providing counseling about end-of-life services drew fire from some Republicans about "death panels" determining care. But Thomas Smith, director of the Johns Hopkins Palliative Care Program, points to studies that show patients in such programs do better on quality measures like hospital readmission rates than people who don't elect palliative care. Patient satisfaction levels improve as well. Dr. Smith also cites studies showing members who receive these benefits live as long as or longer than those who aren't participants.

More..

http://online.wsj.com/news/articles/SB10001424052702303942404579363050214972722

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[sinkingfeeling]

1. Our problem with our 95 yr.-old mother is finding a doctor who will

take, "I don't want to be treated for this" and just provide palliative care. I guess they just can't get enough money without a dozen tests and 5 or 6 prescriptions.

[badtoworse]

2. Have you spoken with Hospice? They were wonderful during the final 6 weeks of my father's life.

[Warpy]

7. They won't take people who have a life expectancy over 6 months.

It wouldn't matter if she were 105, unless she had a disease process likely to be terminal within that period, she's too healthy for hospice.

That's a shame, really.

[question everything]

8. I am so sorry to hear this

Can Medicare offer any help? Or her other insurance?

Perhaps someone can convince a hospice to take her in since, really, no one can tell how longer one will leave?

[sinkingfeeling]

10. It's the Medicare doctors who want to treat, treat, treat her. She is blind and

has kidney disease and can't walk. The doctors want to treat her for hyperthyroidism, anemia, sore feet, etc. One even wanted to put her on dialysis. She keeps saying "no".

[Pretzel_Warrior]

3. My 62 yr old mother was diagnosed with stage IV lung cancer

In 2010. She only lasted 4 and a half months after diagnosis, but palliative care was the thing of prime importance for those months.

Same with my twin sister who was diagnosed with recurrent cervical cancer in 2011. She lasted about 10 months after diagnosis and had lower pain threshold. She received very good palliative care and a lot of wonderful therapies provided by Hope Hospice.

I am guessing pain relief was not only beneficial to them and us but also resulted in cost savings to the entire system.

And by the way, cancer sucks.

[csziggy]

4. During my Dad's final illness he was put into palliative care

The major focus was to keep him comfortable. We then put him into hospice care and the particular hospice service we chose allowed Dad to stay at the same hospital in the same room. Hospice added additional levels of attention to his comfort and counseling for family members.

I was very pleased with the care Dad got and have to give Lakeland (Florida) General Hospital's Palliative Care Ward and Crossroads Hospice a lot of credit for making his final days easier for him and for the family.

[greymattermom]

5. they did this to my mother after she fractured her pelvis

Massive iv drugs.
No food.
No water.

Took her a week to die.

It's euthanasia, IMO.

[MoonRiver]

6. No food, no water is not palliative care. Palliative care is strictly pain alleviation.

I have heard some hospice programs do that for people who are very close to death.

[question everything]

9. This is really inhumane. I am so sorry that you had to go through this

I am sure you are relieved to have this sad affair behind you. But I wonder whether contacting your state medical board, or whoever regulates them and at least asking questions, may at least help the next poor souls.