Editor’s note: The following post, on palliative care in the long term setting, is authored by Mary Ersek and David Stevenson (photos and linked bios above) and by Justine Sefcik, MS, RN, a fourth year doctoral student at the University of Pennsylvania School of Nursing, a 2012-2014 National Hartford Centers of Gerontological Nursing Excellence Patricia G. Archbold Scholar, and a previous Jonas Hartford Scholar. The post is the first in a periodic Health Affairs Blog series on palliative care, health policy, and health reform. The series will feature essays adapted from and drawing on an upcoming volume, Meeting the Needs of Older Adults with Serious Illness: Challenges and Opportunities in the Age of Health Care Reform, in which clinicians, researchers and policy leaders address 16 key areas where real-world policy options to improve access to quality palliative care could have a substantial role in improving value.
As we begin the series, we offer the following short introduction from Diane Meier and Amy Kelley: “Because of its focus on quality of care, the Affordable Care Act is poised to expand access to palliative care services for the sickest, most vulnerable, and therefore most costly, 5 percent of patients, who drive about 50 percent of all healthcare spending. Palliative care is specialized medical care for people with serious illnesses that focuses on providing relief from symptoms, pain, and stress, whatever the diagnosis or stage of illness. Patients (and family caregivers) receiving palliative care experience improved quality of life, better symptom management, lower rates of depression and anxiety, and improved survival. Because patient and family needs are met, crises are prevented, thereby directly reducing need for emergency department and hospital use and their associated costs.”
…What is meant by a “person- and family-centered approach?” It is care that starts with understanding what matters most to the patient and their loved ones, and then building a care plan to achieve the goals that they articulate. Palliative care is a growing model for enhancing LTSS that aligns well with the Commission’s recommendations. CMS defines palliative care as “patient and family-centered care that optimizes quality of life by anticipating, preventing, and treating suffering.”
…Although these emerging palliative care models hold great promise for enhancing LTSS, additional policy changes are needed to integrate palliative care services more fully into nursing homes. First, CMS should ensure that palliative care and hospice are included in payment models that seek to integrate LTSS with acute and post-acute care (e.g., accountable care organizations, medical homes, and bundled payment demonstrations), provided sufficient safeguards are included to ensure quality of care. Second, policymakers could allow some package of palliative care and hospice services to be delivered alongside SNF care, mitigating the barrier the SNF benefit poses to hospice utilization currently. Similarly, hospice eligibility policies could be re-evaluated in the context of how the benefit is currently used. Third, regulatory and performance-based payment and reporting efforts should incorporate performance measures that are appropriate for patients with advanced illness.
We will continue to watch this series of essays and will post new ones for both our readers and our clients. Remember we here at California Living Trust.com are here to answer all of your questions!
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December 18 , 2013
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