Cancer care is expensiveboth 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, Kamals 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 doesnt 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 careespecially unreimbursed caregoes 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 visitsall 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.
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The Immeasurable Benefits of Palliative Cancer Care - Managed Healthcare Executive
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