Download Variation in Total Hospice Payments per Beneficiary * FY2014

Conceptual Shift for Palliative Care
Life Prolonging Care
Life Prolonging
Care
Medicare
Hospice
Benefit
Hospice Care
Palliative Care
Dx
Not
this
But
this
Death
2
Hospice
• Eligibility restricted by
prognosis/willingness to give up
disease Rx
• 46% of all U.S. deaths served (2014)
• Median length of service: 17 days
• At home: 60%
• Over age 65: 84%
• Outcomes: better QOL, lower cost
https://www.nhpco.org/sites/default/files/public/Statistics_Research/2015_Facts_Fig
Doubling in Number of Hospices
2000 - 2015
4500
3,925
4000
4,092
4,199
2014
2015
3,250
3500
3000
2500
2,255
2000
1500
1000
500
0
2000
2007
2013
Number of Hospices
Source: MedPAC March 2017 Report to Congress
Geographic Variation in Access: % of
Medicare Decedents Receiving Hospice –
CY2014
21-39%
40-49%
50-59%
> 60%
Source: CMS Hospice PUF Files, October 2016 for patients who received at least 1 day of hospice care in CY2014
Click on a state to change color
Hospital Palliative Care Growth in the U.S.
►In
2015, hospital
programs were serving over
8MM patients each year.
►Palliative
care prevalence
and # of patients served
has more than tripled
since 2000.
►
100% of the U.S. News 2014 – 2015 Honor Roll Hospitals Have a
Palliative Care Team.
►
100% of the U.S. News 2014 – 2015 Honor Roll Children’s
Hospitals Have Palliative Care Teams.
Palliative Care is Present at:
100%
Of the top 20 NIH-funded medical
schools
97%
of the Council of Teaching Hospitals
member organizations
87%
of the National Cancer Institute’s
87%
designated comprehensive cancer
centers
Geographic Variation in Hospital Palliative Care
https://reportcard.capc.org/
http://online.liebertpub.com/toc/jpm/0/0
Palliative Care Improves Value
Quality improves
– Symptoms
– Quality of life
– Length of life
– Family satisfaction
– Family bereavement
outcomes
– MD satisfaction
Costs reduced
– Hospital cost/day
– Use of hospital, ICU,
ED
– 30 day readmissions
– Hospitality mortality
– Labs, imaging,
pharmaceuticals
Mr. B
•
2015: An 88 year old man with
dementia admitted via the ED for
management of back pain due
to spinal stenosis and arthritis.
• Pain is 8/10 on admission, for which
he is taking 5 gm of
acetaminophen/day.
• Admitted 3 times in 2 months for
pain (2x), falls, and altered mental
status due to constipation.
• His family (83 year old wife) is
overwhelmed.
Mr. B:
• Mr. B: “Don’t take me to the
hospital! Please!”
• Mrs. B: “He hates being in
the hospital, but what could I
do? The pain was terrible
and I couldn’t reach the
doctor. I couldn’t even move
him myself, so I called the
ambulance. It was the only
thing I could do.”
Modified from and with thanks to Dave Casarett
Before and After
Usual Care
Palliative Care at Home
• 4 calls to 911 in a 3 month
period, leading to
• 4 ED visits and
• 3 hospitalizations, leading
to
• Hospital acquired infection
• Functional decline
• Family distress
•
•
•
•
•
•
•
Housecalls referral
Pain management
24/7 phone coverage
Support for caregiver
Meals on Wheels
Friendly visitor program
No 911 calls, ED visits, or
hospitalizations in last 2 years
Access to Palliative Care in
Community Settings
How do we get from here to there?
• Today’s sessions will demonstrate a number of
serious illness models shifting care for patients
like Mr. B. out of EDs and hospitals and into
homes and community.
• Listen for the common characteristics.
• Think about policy and delivery system changes
necessary to make the community based care
and social service supports you will hear about
today into the standard of care for people with
serious illness.