Life is sweet at home

Part II: Palliative care reduces costs, delivers better outcomes

The title of a recent article published in USA Today says it all:

10,000 SENIORS COST MEDICARE $1 BILLION; CONTAINING COSTS A CHALLENGE AS NATION AGES

Hospice caregivers are specially trained.

Well, actually, the real problem is multi- fold: cost, quality and quantity.  Due to astronomical costs, lack of effective strategies as well as the explosion of older people with multiple chronic diseases, the nation’s health care system is overwhelmed. As a result, palliative care is beginning to be valued as a means to better outcomes all around.

The Cinderella of medical specialties, palliative care is shaking off its dowdy, dutiful exterior to offer those in need transformative care at substantial cost savings to families and the nation.  This second blog continues our look at the role of palliative care. Please see Part I: Overlake Hospital physician explains palliative care.

The few cost the system the most

According to the article above, research showed that two-thirds of traditional Medicare beneficiaries older than 65 have multiple chronic conditions. More than 4 million — about 15% — have at least six long-term ailments. Those sickest seniors account for more than 41% of the $324 billion spent on traditional Medicare.

In addition, with 10,000 not-very-healthy boomers jumping on the Medicare rolls ever day, the budget is stretched even further. Living longer than the previous cohort, many boomers will  grapple for decades with a full menu of serious illnesses.

How the costs, frustrations mount up

Karen Knops, MD, medical director of Overlake Hospital Palliative Care

Karen Knops, MD, medical director of Overlake Hospital Palliative Care in Bellevue, recommended the Center to Advance Palliative Care (CAPC) website (capc.org) as a great resource. One of the site’s blogs discusses how those with serious illness (cancer, advanced heart disease, dementia) face a much greater risk of crisis hospitalization and preventable spending.

For example, research indicates that people diagnosed with cancers of the brain, esophagus, liver or lung have a one-in-three chance of at least one hospital admission every six months, and as much as a 40% chance of at least one Emergency Department (ED) visit in that same time period.

John’s story underscores the distress that often comes with repeated admissions:

John was diagnosed with esophageal cancer several months ago and is undergoing second-line therapy. The pain is “terrible,” and during another sleepless night, his overwhelmed and exhausted wife calls his doctor. She hears a taped voice telling her to hang up and call 911 if it is an emergency. This results in their fourth trip to the ED in three months. 

After the last ED visit, John was admitted to the hospital for five days, followed by twenty-one days of post-acute rehabilitation, with little change to his treatment plan or his symptom burden.

On this fourth visit to the ED, his pain is an eight on a scale of one to ten, for which he is taking a dangerously toxic dose of 5,000 mg of acetaminophen every day without relief. 

At this point, the family is labeled a “frequent flier” and considered to be “abusing” the ED, despite their appropriate use of the only solution available to them.

Palliative care to the rescue

Just as Cinderella wasn’t noticed until someone needed her (or she got gussied up), palliative care is beginning to get noticed by the health care system for its many attractive characteristics. As Dr. Knops said, palliative care provides personal, holistic and humanistic medicine. As an off-shoot of providing an improved quality of life, the palliative care model also offers alternatives to costly ED visits and readmissions.

“A lot of medical services to treat the elderly with chronic diseases are expensive and burdensome,” observed Dr. Knops. “Often they just are not needed.”

In Part III: Five characteristics of top-notch palliative care, we will take a deeper look at the personal benefits of palliative care and how people can learn more about it.

For more information:

Overlake Hospital Palliative Care: 

Overlake Hospital Medical Center
1035 116th Ave NE
Bellevue, WA 98004

Phone: 425.688.5000

https://www.overlakehospital.org/department/inpatient-palliative-care-consult-service