As more hospices diversify their services to include palliative care, 71% of adults in the United States are unaware that the service exists, a recent Journal of Palliative Medicine (JPM) study found.
Similar to hospice, palliative care provides non-curative treatment to improve comfort and quality of life for patients. Unlike hospice, providers offer palliative care to patients who are not expected to die within six months. Palliative care can be provided at any point during a patient’s illness.
Palliative care is often a loss leader for hospice providers, though many expect growth in the long term. That growth, however, is contingent on getting the word out to more patients, families, and in some cases, clinicians, many of whom conflate palliative care with hospice care.
“I think you cannot go into palliative care at this point thinking that you are going to make a profit for your organization,” said Laura Archuleta, MD, a palliative care physician with CHI-St. Alexius Medical Center, which providers inpatient and home-based palliative and hospice care. “Where you see benefits from an institutional standpoint is cost avoidance. There are large pools of data on decreased inpatient length of stay, decreased readmissions, and decreased emergency department.”
Within the next two decades palliative care has the potential to reduce societal health care costs by $103 billion, according to the nonprofit economic research group Florida TaxWatch. Research published in a July 2017 issue of Health Affairs estimated that palliative care could reduce health care costs by more than $4,000 per patient.
Awareness of palliative care varied among different demographic groups, the JPM study indicated. Among the U.S. population, senior citizens, individuals with college degrees, women, and caucasians were more likely to have heard of palliative care than members of other groups.
Awareness of the existence of palliative care, however, is not the same as knowing what palliative care is.
Some patients and families attach stigma to palliative care, associated it with likelihood of death, hopelessness, and dependency. Clinicians are not immune to these misperceptions, and physicians have cited these stigma as a cause of late referrals to palliative care.
“The overarching theme was that health care professionals held contradictory understandings of palliative care and its application,” a 2015 study indicated. “There are entrenched contradictions and tensions surrounding the term “palliative care”; confronting these is likely to require more than re-branding.”
Despite these challenges, many in the industry believe that palliative care is poised for growth. Hospice by the Bay, a San Francisco-area hospice provider, has seen steady increases in its palliative care census, currently treating 130 patients, up from 50 during 2018.
“Palliative care right now is in its infancy, and it’s difficult to make money on it, but that is going to change,” Hospice by the Bay CFO Denis Viscek said. “Medicare hasn’t fully embraced it yet, but more private insurance companies are starting to cover it. I recently told our board that there is going to be a day when our palliative care census exceeds our hospice census.”