"I think it’s great the health plans are doing it," he said. "People are asking for good pain and symptom management now more than ever before."
The growth of accountable care organizations (ACOs) is also driving the expansion of palliative care programs. Because ACOs assume risk for the total cost of their members’ health care, expanding palliative care services in the community offers the potential to lower costly hospital admissions and readmissions, Dr. Schumacher said. Even though ACOs are developing very differently depending on the local community, they all seem interested in hospice and palliative care programs, he said.
Dr. Diane E. Meier, director of the Center to Advance Palliative Care, recently created a toolkit for payers outlining the rationale for establishing a palliative program and elements with a proven track record of improving quality and decreasing costs. For instance, a meaningful 24/7 clinical response is an essential element, she said, because it keeps patients from calling 911 frequently and ending up in the emergency department.
"Payers are recognizing that the reason their members don’t get access to palliative care in the community is because no one will pay for it – and they can fix that," said Dr. Meier, who is also a professor of geriatrics and palliative medicine at Mount Sinai Hospital in New York.
But expanding access to palliative care is likely to take more than just financial incentives, said Dr. Krakauer. The difficulty in making changes to health care delivery is one obstacle, he said. Another issue is that palliative care still runs contrary to the medical culture.
"A physician might feel that this represents personal failure as a professional, and he may feel that this is not what his patients would expect of him," Dr. Krakauer said. "We know this isn’t true, but I think that this type of feeling is persistent."
mschneider@frontlinemedcom.com
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