Hospice & Palliative Care August 4, 2009 Christian Sinclair, MD, FAAHPM Kansas City Hospice & Palliative Care
90 million Americans are living with a life-threatening illness…
And the number is expected to double in the next 25 years.
 
 
Hospice & Palliative Care Symptom Control System Efficiency Medication Prioritization Communication Informed Consent
Trans-disciplinary Team Physician Nurse Volunteer Chaplain Social Worker Pharmacist
What’s The Difference? Palliative Care Hospice
 
15 12 3 2 1 1
 
 
 
 
 
 
 
 
 
 
Reduces Medicare Costs
 
 
 
 
 
 
 
 
 
 
State Policy Recommendations <ul><li>Fund palliative care (PC) team training & technical assistance for all hospitals </li...
State Policy Recommendations <ul><li>Require all state-supported medical schools to have affiliations with hospital PC pro...
Resources <ul><li>AAHPM –  www.aahpm.org </li></ul><ul><li>NHPCO –  www.nhpco.org </li></ul><ul><li>MHPCA –  www.mhpca.org...
References <ul><li>NHPCO Facts and Figures: Hospice Care in America. Alexandria, VA: National Hospice and Palliative Care ...
Contact Information <ul><li>Christian Sinclair, MD </li></ul><ul><ul><li>Kansas City Hospice & Palliative Care </li></ul><...
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Hospice & Palliative Care Missouri Health Net Aug 2009

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Presentation to Missouri HealthNet (State Medicaid Program) about hospice and palliative care issues. Please see accompanying handout for facts presented in presentation.

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  • Picture Ref: http://www.flickr.com/photos/84204480@N00/115633741/ User Squishband Approximately ninety million Americans are living with serious and life-threatening illness, and this number is expected to more than double over the next twenty–five years with the aging of the baby boomers. Yet, studies show that most people living with a serious illness experience inadequately treated symptoms; fragmented care; poor communication with their doctors; and enormous strains on their family caregivers.
  • http://www.flickr.com/photos/squishband/116055440/sizes/o/ User Squishband Approximately ninety million Americans are living with serious and life-threatening illness, and this number is expected to more than double over the next twenty–five years with the aging of the baby boomers. Yet, studies show that most people living with a serious illness experience inadequately treated symptoms; fragmented care; poor communication with their doctors; and enormous strains on their family caregivers.
  • http://www.flickr.com/photos/jkgroove/191905347/sizes/l/ User johnnyalive Studies show that most people living with a serious illness experience inadequately treated symptoms; fragmented care; poor communication with their doctors; and enormous strains on their family caregivers.
  • A relatively new medical subspecialty, palliative medicine is focused on improving quality of life—and quality of care—for seriously ill patients and families. Palliative care provides comprehensive symptom management, intensive communication and coordination of care that addresses the episodic and long-term nature of serious, chronic illness. Patients therefore benefit from well-controlled symptoms, improved patient-physician-family communication and satisfaction with their care. Delivered by a palliative care team, hospital palliative care programs enhance the efficiency and effectiveness of hospital services.
  • A relatively new medical subspecialty, palliative medicine is focused on improving quality of life—and quality of care—for seriously ill patients and families. Palliative care provides comprehensive symptom management, intensive communication and coordination of care that addresses the episodic and long-term nature of serious, chronic illness. Patients therefore benefit from well-controlled symptoms, improved patient-physician-family communication and satisfaction with their care. Delivered by a palliative care team, hospital palliative care programs enhance the efficiency and effectiveness of hospital services.
  • Image Ref: http://www.flickr.com/photos/7197250@N06/495524570/ User a.drian In 2007, there were 2,883 physicians board-certified in palliative medicine (1 physician per 31,000 persons living with serious and life-threatening illness, or 1 physician per 432 Medicare deaths from chronic illness). In comparison, there are 16,800 cardiologists (1 per 71 heart attack victims) and 10,000 oncologists (1 per 145 patients newly diagnosed with cancer).
  • Image ref: http://www.missouri-map.org/detailed.htm AAHPM Physician Members
  • Our data indicate that in states where there is greater access to palliative care programs, patients: Are less likely to die in the hospital Experience fewer ICU/CCU admissions in the last six months of life Spend less time in an ICU/CCU in the last six months of life
  • In 2007, an estimated 1.4 million patients received services from hospice (Figure 2). This estimate includes: • 930,000 patients who died under hospice care in 2007; • 258,000 who remained on the hospice census at the end of 2007 (known as “carryovers”); and • 222,000 patients who were discharged alive in 2007 for reasons including extended prognosis, desire for curative treatment, and other reasons (known as “live discharges”). 38.8% of all deaths in the United States were under the care of a hospice program (Figure 3). 2.4m deaths 0.93 mil on hospice
  • Approximately 30.8% of those served by hospice died or were discharged in seven days or less, and 13.1% died or were discharged in 180 days or more. The median (50th percentile) length of service in 2007 was 20.0 days, a slight decline from 20.6 days in 2006. This means that half of hospice patients received care for less than three weeks and half received care for more than three weeks. The average length of service increased to 67.4 days (from 59.8 in 2006) (Figure 4).1
  • Findings of a major study demonstrated that hospice services save money for Medicare and bring quality care to patients with life-limiting illness and their families.6 Researchers at Duke University found that hospice reduced Medicare costs by an average of $2,309 per hospice patient. Additionally, the study found that Medicare costs would be reduced for seven out of 10 hospice recipients if hospice has been used for a longer period of time. For cancer patients, hospice use decreased Medicare costs up until 233 days of care. For non-cancer patients, there were cost savings seen up until 154 days of care. While hospice use beyond these periods cost Medicare more than conventional care, the report’s authors wrote that “More effort should be put into increasing short stays as opposed to focusing on shortening long ones.”?
  • For State Policymakers Fund palliative care team training and technical assistance for all hospitals in your state. Include palliative care indicators in your state&apos;s quality programs for your state health plan and Medicaid programs. Ensure the development of palliative care programs in public and sole community provider hospitals, as these hospitals provide care to the underserved and most vulnerable patient populations. Promote and pass legislation requiring all state-supported medical schools to have affiliations with hospital palliative care programs. Create a statewide resource center for promotion of access to quality palliative care services (see New York Palliative Care Training Act-Public Health Law Article 28 at http:// public.leginfo.state.ny.us/menuf.cgi ) Promote and pass legislation that requires physicians take continuing medical education (CME) courses on pain management and care of the terminally ill. An example of legislation can be found at California&apos;s Business and Professions Code section 2190.5. http://www.leginfo.ca.gov/cgi-bin/displaycode?section = bpc&amp;group =02001-03000&amp;file=2190-2196.5
  • For State Policymakers Fund palliative care team training and technical assistance for all hospitals in your state. Include palliative care indicators in your state&apos;s quality programs for your state health plan and Medicaid programs. Ensure the development of palliative care programs in public and sole community provider hospitals, as these hospitals provide care to the underserved and most vulnerable patient populations. Promote and pass legislation requiring all state-supported medical schools to have affiliations with hospital palliative care programs. Create a statewide resource center for promotion of access to quality palliative care services (see New York Palliative Care Training Act-Public Health Law Article 28 at http:// public.leginfo.state.ny.us/menuf.cgi ) Promote and pass legislation that requires physicians take continuing medical education (CME) courses on pain management and care of the terminally ill. An example of legislation can be found at California&apos;s Business and Professions Code section 2190.5. http://www.leginfo.ca.gov/cgi-bin/displaycode?section = bpc&amp;group =02001-03000&amp;file=2190-2196.5
  • Hospice & Palliative Care Missouri Health Net Aug 2009

    1. 1. Hospice & Palliative Care August 4, 2009 Christian Sinclair, MD, FAAHPM Kansas City Hospice & Palliative Care
    2. 2. 90 million Americans are living with a life-threatening illness…
    3. 3. And the number is expected to double in the next 25 years.
    4. 6. Hospice & Palliative Care Symptom Control System Efficiency Medication Prioritization Communication Informed Consent
    5. 7. Trans-disciplinary Team Physician Nurse Volunteer Chaplain Social Worker Pharmacist
    6. 8. What’s The Difference? Palliative Care Hospice
    7. 10. 15 12 3 2 1 1
    8. 21. Reduces Medicare Costs
    9. 32. State Policy Recommendations <ul><li>Fund palliative care (PC) team training & technical assistance for all hospitals </li></ul><ul><li>Include PC indicators in state quality programs </li></ul><ul><li>Ensure the development of PC programs in public and sole community provider hospitals </li></ul><ul><ul><li>as these hospitals provide care to the underserved and most vulnerable patient populations. </li></ul></ul>
    10. 33. State Policy Recommendations <ul><li>Require all state-supported medical schools to have affiliations with hospital PC programs. </li></ul><ul><li>Create a statewide resource center for promotion of access to quality PC services </li></ul><ul><ul><li>See NY Palliative Care Training Act-Public Health Law Article 28 http:// bit.ly/vvWOf </li></ul></ul><ul><li>Require physicians take CME on pain management and care of the terminally ill. </li></ul><ul><ul><li>See CA Business and Professions Code section 2190.5. http:// bit.ly/dAqLL </li></ul></ul>
    11. 34. Resources <ul><li>AAHPM – www.aahpm.org </li></ul><ul><li>NHPCO – www.nhpco.org </li></ul><ul><li>MHPCA – www.mhpca.org </li></ul><ul><li>Pallimed – www.pallimed.org </li></ul><ul><li>CAPC – www.capc.org </li></ul>
    12. 35. References <ul><li>NHPCO Facts and Figures: Hospice Care in America. Alexandria, VA: National Hospice and Palliative Care Organization, October 2008. http://bit.ly/5YNAh </li></ul><ul><li>Center to Advanced Palliative Care. http://www.capc.org/reportcard/ </li></ul><ul><li>D.H. Taylor Jr et al. / Social Science & Medicine 65 (2007) 1466–1478. http:// bit.ly/bClPN </li></ul>
    13. 36. Contact Information <ul><li>Christian Sinclair, MD </li></ul><ul><ul><li>Kansas City Hospice & Palliative Care </li></ul></ul><ul><li>Email: [email_address] </li></ul><ul><li>Twitter: @ctsinclair </li></ul><ul><li>Find me on LinkedIn </li></ul>

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