How can palliative care gain the respect it deserves?
Even though palliative care has been recognized as a board-certified medical specialty for nearly 15 years, it still may be the most misunderstood and underutilized. Consider it the Rodney Dangerfield of medical specialties – especially for those who don’t grasp its tremendous value.
Surveys during the last decade show an uptick in consumers who say they have at least heard the term “palliative care” (moving from around 30 percent to 40 percent or more), but only about 10 percent claim they could give a good definition of the service. Which isn’t a big surprise. I’ve heard a tongue-in-cheek remark that says if you ask 10 providers of palliative care to define it, you’ll get 11 different answers.
Indeed, the way palliative care is delivered can vary greatly from provider to provider. A major factor in this disparity starts with CMS’s relatively weak reimbursement stream for palliative care. Reimbursement for a palliative consult with a physician, nurse practitioner and licensed social worker seems to be the basic model. Different providers then layer on a variety of relevant services depending on their mission, business model and strategic plan.
Another factor is that physicians and other referrers also can lack clarity on exactly what palliative care is and when it’s appropriate. In fact, surveys conducted by Center to Advance Palliative Care (CAPC) revealed a vast majority of physicians admitted they did not distinguish palliative care from hospice care. They said palliative care is comfort care for the very end of life.
That definition, of course, describes hospice care more accurately than palliative care. And that misunderstanding overlooks some very important facts – particularly that palliative care can be applied at any stage of a serious illness, does not require a six-month life expectancy and works in tandem with curative treatments (not instead of them).
In a recent conversation with Melanie Marien, RPA-C – a nationally certified Physician Assistant and palliative care specialist – she shared her thoughts on whether this specialty is getting traction and how to help it gain greater acceptance.
“There still remains a lot of confusion both in the lay community and the medical community about what palliative care is, and confusion with hospice and how it’s the same and how it differs,” Melanie said. “I think we need to continue to reinforce in the medical community that it’s truly collaborative care; that it’s more care, not less care
“I think there’s also confusion who delivers it and where to get it, and there’s just a disparity nationwide who’s delivering it. Rural areas often present challenges in care, and I think that’s true for hospice care and palliative care. Some people can get it in the hospital and then there’s no extension into the community.”
Melanie also discussed ideas on referring patients to palliative care as early as appropriate. “I think the referral process goes hand in hand with education,” she said. “We have come a long way with advanced analytics and people use that for predictive modeling and a proactive approach to diseases and how to keep patients healthy. Palliative care is best when started early before patients have high symptom burden and are in an insufferable state. And that I think we can rely, for example, on some of our ERs. There are protocols for strokes when patients go into an emergency room. There are protocols for heart attacks. Why can’t there be protocols to identify patients with high symptom burden and involve palliative care and then have that extend past their acute hospital stay into the community?”
When it comes to relieving overall healthcare costs, providing family caregiver support at home and other big advantages of increasing palliative care utilization, Melanie had much more to say. You can hear the full interview on our latest podcast.
Want to discuss how to better educate your community and referral sources about the many benefits of palliative care? Contact me at firstname.lastname@example.org.