Evidence proves hospice, palliative care quality

October 1, 2010

It will be critical to have appropriate awareness campaigns in the area of palliative and hospice care services

Americans are notorious for choosing our words carefully, whether it's in the interest of political correctness, social sensitivity or simply as a marketing tactic. However, strategic wording can often be counterproductive, causing confusion and muddling the message.

For example, since the 1970s, we've referred to head-to-head studies of clinical treatments as "comparative effectiveness research," or CER. Now, as described in the Patient Protection and Affordable Care Act, we have new wording: "patient-centered outcomes research." Apparently that's CER with a little marketing spin.

Fear of the Untruth

Of course, such wordsmithing also causes negative effects among consumers, who might put their own health at risk because they're afraid of something that amounts to a poor misinterpretation.

For example, more than one-third of seniors mistakenly believe the reform law includes government "death panels" that will make decisions on end-of-life-care for those in Medicare, according to a survey released in July by the Kaiser Family Foundation. Undoubtedly, many of those seniors will shy away from the benefits of appropriate palliative and hospice care because they'll view the services as cold cost-saving measures instituted by health plans and governments.

Palliative and hospice services can and do provide benefits, and it's going to be up to managed care to start conversations on how stakeholders might increase awareness and offer educational efforts. The absence of good information about these services is as much a contributor to the fearfulness as the presence of bad information.

Yes, it will be extremely difficult to create awareness programs that don't make insurers and providers appear insensitive in the current environment of consumer distrust, but collaborative efforts will be worth the time investment. There is a clear value proposition for payers: One-fourth of Medicare spending is dedicated to the 5% of patients who are in their final year of life, and much of the care offers little benefit for the patient's longevity or quality of life.

A study released in the August 19 issue of the New England Journal of Medicine showed that cancer patients who received palliative care from the moment of their diagnosis along with standard treatment lived twice as long as patients receiving cancer treatment alone. And they were spared much of the physical and emotional effects often accompanying terminal illness.

To begin making inroads, the reform law establishes 15 concurrent-care demonstration projects, in which Medicare will cover hospice and curative treatment simultaneously. The projects could create a turning point.

Patients, families, physicians and health plans can all agree that hospice and palliative programs must center on each patient's own definition of what is acceptable care. Discussions don't necessarily need to involve costs, because quality of life trumps all. The evidence is there, and it's time for managed care to begin addressing this difficult issue in a straightforward way.

Julie Miller is editor-in-chief of MANAGED HEALTHCARE EXECUTIVE. She can be reached at julie. miller@advanstar.com