Palliative care is coming to Indian River Medical Center. At least, Dr. Arif Kamal, an assistant professor of medicine and director of quality and outcomes at the Duke Cancer Center of Durham, NC, says the prognosis for that is, “Very good.”
“In assessing this hospital’s readiness, I think they are way ahead (of other hospitals). They get it. The culture among the clinicians here is ripe for putting a palliative care program in place and I think they also sense that the community would be very receptive to that kind of a service.”
Kamal, who regularly consults with hospitals looking into palliative care programs, was speaking after a closed-door meeting at IRMC on January 12. He explained he was here in Vero Beach, “talking about what the future of palliative care could be here at IRMC and ways to make it successful, sustainable and able to reach the maximum number of patients.
Of course, if you’re like most Americans, you may not be quite sure just what palliative care is and what it entails. Surveys have repeatedly found most folks don’t have a clear fix on the term and that those who think they do often get it wrong.
The term suffers from a kind of identity crisis. As often as not, palliative care is confused with end-of-life hospice care. As the New York Times reported last September, “This mistaken association can make a palliative care consultation feel like a death sentence to even the most open-minded clinicians, patients and family members.”
Dr. Kamal says “that’s a problem shared by patients, caregivers and clinicians alike, so it’s important to make that distinction between hospice and palliative care.”
In the simplest of terms, palliative care is specialized medical treatment for people with serious, though not necessarily life-threatening illnesses. While hospice patients are facing end-of-life decisions, palliative care patients can expect to live many more years and live those years with a better “quality of life” than they might otherwise have anticipated. Palliative care focuses on providing patients with relief from their symptoms of pain, stress, depression and more so they can function as normally as possible for as long as possible.
Perhaps part of the confusion about “hospice care” and “palliative care” stems from the fact that they are both relatively new terms in the medical lexicon. As Kamal points out, hospice in the United States has only been around for about a few decades and Medicare only recognized palliative care as a viable form of treatment in 2008.
In fact, just 10 years ago this there was little training available on palliative care in any of the nation’s medical schools. Things have changed. Today, “the vast majority of America’s medical schools now have palliative care programs and are teaching medical students and residents about palliative care,” according to Dr. Diane Meier, director of the Center to Advance Palliative Care at Mount Sinai School of Medicine in New York City.
While it is true that palliative care often appears to center on managing the symptoms of potentially life-threatening diseases such as congestive heart failure, chronic obstructive pulmonary disease, kidney failure, Alzheimer’s and others, its overall goal is simply to improve any patient’s quality of life while also easing the gut-wrenching concerns of that patient’s family members. When a loved one appears to be in pain it’s difficult for those caregivers and family members to focus on anything else.
The development of palliative care centers in hospitals around the country may be, as Kamal says, “just the right thing to do.” Certainly large numbers of hospitals nationwide have hopped on the bandwagon. Mount Sinai’s Meier says that today nearly 90 percent of American hospitals with at least 300 beds now offer palliative care consultation services.
A more cynical view of this rapid growth of palliative care, however, might suggest it’s not an entirely altruistic decision. There are, after all, hundreds of millions if not billions of dollars at stake.
The Affordable Care Act now allows the government to impose stiff Medicare reimbursement withholdings or fines on hospitals that repeatedly re-admit Medicare patients with chronic or recurring conditions and symptoms. Since palliative care has been shown to reduce patient re-admissions and dependency on emergency room use and hospitalizations, it will likely save those hospitals many millions of Medicare dollars. (Medicare doesn’t just withhold a percentage of the reimbursements for patients who are readmitted, it withholds that percentage from all Medicare reimbursements for that hospital.)
According to the New York Times, up to 90 percent of trips to emergency rooms for Medicare patients are triggered by the symptoms – pain, shortness of breath, fatigue and such – that accompany chronic illnesses: The same symptoms that can be prevented or managed by palliative care specialists in the patient’s own home or at a palliative care facility.
Whatever the motivation, palliative care has made enormous strides in a very short period of time. It is now recognized and (largely) paid for by Medicare and a vast majority of private insurers, too. And while no official announcement has been made and no date has been given for the start of IRMC’s palliative care program, it is clear that work is already underway.
As Kamal says, “Right now we’re still trying to evaluate which are the best kind of services that are in demand and can be supported,” while adding that “It’s relatively easy to start a program but it’s harder to create one that will sustain itself and grow” and that appears to be the direction in which IRMC is headed.