Comments on GeriPal - Geriatrics and Palliative Care Blog: What if palliative care doesn't save money?

Thanks James, appreciate the comment. I think the...

2012-01-06T16:37:37.243-08:00

Thanks James, appreciate the comment. I think the cost savings of inpatient palliative care are pretty clear. My major concern is with outpatient programs, like the one by Bakitas in the JAMA paper above. The financial model for outpatient palliative care is not well established. I'm hopeful that health care reform, with the increased focus on packaging inpatient and outpatient care, will result in greater attention to the potential cost savings associated with outpatient care.

That said, that's not why we should do it. Like Australia, we should do it because it's best for patients and families. This being a country that doesn't generally do the right thing unless it aligns with private interests, however, reducing admissions will probably be the mechanism that drive growth of outpatient palliative care. But it's not the best reason.

Alex - nice post! I have two thought about this. ...

2012-01-05T18:23:20.026-08:00

Alex - nice post! I have two thought about this. First, if this is true, are we to worry about the funding of palliative care in 5 years? Many programs (including our own) are seeing huge infusions of dollars expressly because our health systems think that we will save money and reduce readmission rates. If this doesn't pan out, will the plug be pulled and we find that we overreached?
The second point counters this. There are countries, such as Australia, where palliative care gained huge traction for reasons not related to cost savings. Now, palliative care is such a part of the landscape that it could never go away there. That is the scenario I hope we can create here. If we build it well, the public won't let it get taken away (for the reasons you articulate).

Great post Alex! We definitely need to manage the...

2009-10-05T12:22:52.931-07:00

Great post Alex! We definitely need to manage the message. I heard a talk recently where the lecturer specifically used the words "unwanted costs" at the end-of-life meaning that if people really understood what they were getting, they wouldn't want many of these interventions (as Ken Convinsky alluded to).

The fact of the matter is that the fee-for-service...

2009-10-05T06:54:39.619-07:00

The fact of the matter is that the fee-for-service reimbursement system encourages uncoordinated futile care. I don't believe it is a coincidence that many of the exemplar palliative care communities in the nation are characterized by highly intergrated medical groups whose incomes are not inextricably linked to performing more procedures. While palliative care should, of course, be promoted based upon improving quality of life, we cannot ignore the fact that there is a great deal of physician revenue generated during late-life care.

Wonderfully said Alex. I think this illustrates t...

2009-10-04T19:34:35.815-07:00

Wonderfully said Alex. I think this illustrates that the discipline needs to really think about how it presents itself. The central raison d'etre for palliative care has been that it improves quality of life and reduces suffering. To the extent that it saves money, it is because it sometimes replaces care that is ineffective, bad for patients, and costly. I am not sure the public fully appreciates that some of the care given to seriously ill patients makes them worse, not better. This is the reason for avoiding such care. The dollar savings is not the motivation, but the fact that harmful care is also expensive just adds to pain. And perhaps the public needs to better understand that the palliative care that may replace other care does not come cheap. Good palliative care is highly labor intensive and requires good highly skilled providers. But it is worth paying for.

"Time to fight for our image"!! Congratu...

2009-10-04T09:57:50.102-07:00

"Time to fight for our image"!! Congratulations on making an important point - NOW is the time to educate people. Palliative medicine is all about improving quality of life and we need to remind the world!

It isn't surprising, after all, that our field...

2009-10-01T23:04:55.222-07:00

It isn't surprising, after all, that our field finds its self vulnerable, and just when we might have guessed HPM would be held up as the clear way through the healthcare debate. There is a risk of our strengths becoming weaknesses on this new center stage we've fought hard to come to. I don't think we can stay as fuzzy anymore. It's a shame we haven't taken proper time to articulate ourselves to the audience. Or, better yet, as Alex frames for us, we would do well to articulate ourselves to the community we serve (and work with, for that matter!).

I totally agree with your post and know that many ...

2009-10-01T20:59:21.700-07:00

I totally agree with your post and know that many in the palliative care field have echoed the "it is not about cost savings" mantra for a long time in many different ways. I agree with your wounded clinician premise for how people find hospice and palliative care whether it be nurses, social workers or doctors.

In terms of the cost versus quality dilemma, I'...

2009-10-01T14:12:33.468-07:00

In terms of the cost versus quality dilemma, I'm with you 100%, i.e., firmly planted in the importance of the quality of life camp. In the end as a society we are faced with the very real need (and thorny problem) of developing systems to pay for care as well as to provide it. We need to develop models, methods and measures that can capture the value of palliative care. This may require looking at palliative care as a family or social unit phenomenon, and evaluating the benefit to immediate family and extended social unit, as well as the individual at end of life. In the end improving quality of life is the right thing to do. Making a case for palliative care to the broader world and financial powers-that-be may require looking beyond the individual death event to benefits that accrue to a patient's remaining social network.

Amen, brother!

2009-10-01T12:19:35.257-07:00

Amen, brother!