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Palliative care offers value and patient-centered care to lung cancer patients.
Cancer care is expensive-both in financial costs for the healthcare system and quality of life costs to the patient. Palliative care can help, but is sometimes misunderstood.
Arif Kamal, MD, MBA, MHS, FASCO, associate professor of medicine, population health sciences and business administration at Duke University, co-authored a paper outlining how palliative care can help improve the value of solid tumors cancers like lung cancer. He says while payers are generally on board with supporting palliative care, there are still a lot of misconceptions.
“Palliative care is not synonymous with end of life care. Often, end-of-life care is seen as the responsibility of hospice, which is not necessarily under the purview of a hospital system or commercial payer,” Kamal says. “Palliative care and hospice are distinct but related. Palliative care should be part of routine operations.”
There is a growing evidence base to support palliative care and integrative medicine in oncology. Both focus on the patient experience during the end of cancer care, and the paper highlights how these services relate to quality of life, healthcare utilization, and more in patients with lung cancer. Palliative care can bring patient-centered and financial value to oncology patients, Kamal’s paper notes, so much so that dedicated attention to palliative and supportive care of lung cancer patients is now a standard of care in national and international guidelines.
Sometimes viewed in error as end-of-life care by patients and even some physicians, palliative care focuses on patient- and family-oriented care that optimizes quality of life issues.
Palliative care has routinely proven its benefits to health systems and commercial payers, Kamal says. Since 2011, he says research has consistently demonstrated avoidance of low-value healthcare costs often associated with advanced illness. Under palliative care, patients can choose to avoid healthcare measures they consider low value to their overall healthcare goals.
While palliative care doesn’t generate revenue, Kamal says, there are significant cost benefits through cost avoidance in the form of lower out-of-pocket costs for patients, lower payments for payers, and lower unreimbursed costs for hospitals.
“Hospitals will consistently see improvements around patient experience,” Kamal adds. “Patient experience scores go up, 30-day readmission rates go down by a third, and the total cost of care-especially unreimbursed care-goes down.”
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In one example from the paper, Kamal and his co-authors share the results from a home-based palliative care trial that enrolled 500 patients and showed a 45% decrease in costs compared to standard care. Patients were happier, had less emergency department visits, hospital stays, skilled nursing facility stays, and physician visits-all thanks to the “extra layer of support” from palliative care. When extending these benefits as a population health strategy, the paper estimates that the reduction in Medicaid spending in New York state alone could be as much as $252 million per year.
“Oncology will always remain one of the most resource-intensive medical disciplines,” Kamal writes in the paper. “Caring for those with substantial morbidity, using methods that are often costly because of their cutting-edge characteristics, while using a multidisciplinary team to address needs from all angles comes at a cost. Yet, we are learning that routine integration of palliative care into oncology care can curb costs that are unnecessary and can prevent health care utilization that is not wanted, all while supporting patient preferences and values.”
When given the choice, patients under palliative care find it easier to say what they really want.
“It’s about giving patients the tools and permission to ask for something different than the status quo,” he says. “The status quo is to escalate, when patients and caregivers may want to hold the course or deescalate.”
Barriers to care
There are few barriers to palliative care when it comes to patients and payers, Kamal says. Often, clinicians are the barrier. They find it difficult to broach the conversation, and there is confusion over which provider should have the discussion. There has to be a culture change, he adds.
“Most payers are on board, but sometimes there’s sort of an under-appreciation of how difficult and complex this really is,” Kamal says. “If you see a lot of complex, seriously ill patients and you only support a program that’s about making sure everyone fills out an advanced directive, it may help, but there’s much more than that.”
Palliative care is truly about delivering the right care to the patient at the right time.
Clinicians can find these conversations difficult, however, and there is a shortage of providers who are trained in offering palliative services. The key, Kamal says, is to make palliative care a part of the larger healthcare culture.
“How do we make these conversations comfortable and not routine? There is a nuance here, and you have to make it part of the culture,” Kamal says. “Palliative care is a population measure delivered at a personal level.”
Rachael Zimlich, RN, BSN, is a writer in Columbia Station, Ohio.