October 2012 Edition Vol.11, Issue 10

The Business Case for Integrating Palliative Care into Oncology Practice

The Business Case for Integrating Palliative Care into Oncology Practice (continued)

When Kaiser Permanente conducted a trial with 298 homebound, terminally ill patients randomized to usual or in-home palliative care plus usual care, the patients receiving in-home palliative care had increased patient satisfaction and reduced use of medical services and costs of medical care at the end of life.¹⁰ The patients enrolled in the palliative care group had an adjusted mean cost of $12,670 ± $12,523, while those receiving only usual care had costs of $20,222 ± $30,026. The palliative care patients had an average cost per day of $95.30, which was significantly lower than the $212.80 average daily cost for the usual care patients. 

The Center to Advance Palliative Care (CAPC) indicates that $6 billion per year could be saved if palliative care was fully penetrated into the nation’s hospitals; however, providing palliative care for all the patients who would benefit is difficult due to the lack of personnel trained in palliative care. CAPC reports that there is only one palliative medicine physician for every 1,200 patients who have a serious or life-threatening illness.⁹ To fill the estimated demand for physicians trained in hospice and palliative medicine, an estimated 6,000-18,000 individual physicians are needed in the area.¹¹

Spragens had several suggestions to overcome the shortage of personnel trained in palliative care. First, she said, “Think hard about roles. Often a social worker can be effective in some of the time-consuming roles and follow-up.” Further, she explained that existing professionally trained staff can build on skills by utilizing existing training such as End-of-Life Nursing Education Consortium (ELNEC) and Education in Palliative and End-of-Life Care (EPEC).

Four factors were described by Spragens as keys to sustaining outpatient palliative care programs. First, be clear about role and goals, anticipate patient use patterns and set aligned expectations, and do not attempt to fill all unmet social needs and structural supports for patients. It is critical to have good skills to collaborate to find solutions instead of taking on all problems. Second, manage to maximize patient convenience and minimize “no show” rates. Third, manage time and schedules. Finally, have reliable and effective billing functions.

Key Points

Palliative care offers time savings and financial benefits, and improves patient outcomes. It must be integrated carefully into an oncology practice, but its addition will benefit the quality of life for patients and their families, along with freeing time and saving money for practicing oncologists. Palliative care provides an extra layer of support that can improve the quality of life for both patients and their families.¹²

References

1. Smith TJ, Temin S, Alesi ER, et al. American Society of Clinical Oncology Provisional Clinical Opinion: The Integration of Palliative Care Into Standard Oncology Care. J Clin Oncol. 2012;30(8):880-887.
2. Temel JS, Greer JA, Muzikansky A, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med. 2010;363(8):733-742.
3. Greer J, McMahon P, Tramontano A, et al. Effect of early palliative care on health care costs in patients with metastatic NSCLC. J Clin Oncol. 2012;30(suppl; abstr 6004).
4. Smith TJ, Hillner BE. Bending the cost curve in cancer care. N Engl J Med. 2011;364(21):2060-2065.
5. Kamal AH, Bull J, Kavalieratos D, Taylor DH, Jr., Downey W, Abernethy AP. Palliative care needs of patients with cancer living in the community. J Oncol Pract. 2011;7(6):382-388.
6. Rabow MW, Smith AK, Braun JL, Weissman DE. Outpatient palliative care practices. Arch Intern Med. 2010;170(7):654-655.
7. Muir JC, Daly F, Davis MS, et al. Integrating palliative care into the outpatient, private practice oncology setting. J Pain Symptom Manage. 2010;40(1):126-135.
8. Hui D, Elsayem A, De la Cruz M, et al. Availability and integration of palliative care at US cancer centers. JAMA. 2010;303(11):1054-1061.
9. Center to Advance Palliative Care. Report Card: America’s Care of Serious Illness. 2011. http://reportcard-live.capc.stackop.com/pdf/state-by-state-report-card.pdf. Accessed June 5, 2012.
10. Brumley R, Enguidanos S, Jamison P, et al. Increased satisfaction with care and lower costs: results of a randomized trial of in-home palliative care. J Am Geriatr Soc. 2007;55(7):993-1000.
11. Lupu D, American Academy of H, Palliative Medicine Workforce Task F. Estimate of current hospice and palliative medicine physician workforce shortage. J Pain Symptom Manage. 2010;40(6):899-911.
12. Kirch RA, Brawley O. Palliative Care: A Lifeline to Quality of Life. J Oncol Practice. 2012;8(2):128-129.