Efforts by individual states to expand palliative care awareness and utilization foreshadow a national trend, with multiple states passing laws or mulling legislation during 2018 and 2019. This comes a time when hospices are increasingly diversifying their services to include palliative care.
This year, Ohio passed a law requiring hospitals, ambulatory surgery centers, nursing homes, and other health care organizations in the state to develop systems to identify patients or residents who are in need of palliative care and inform them about the benefits and availability of those services.
Kentucky in March approved legislation creating a Palliative Care Interdisciplinary Advisory Council and a professional information and education program to help foster palliative care awareness. New Jersey is currently considering similar legislation.
As of Dec. 2018, 27 states have laws on their books designed to promote palliative care, according to the National Academy of State Health Policy (NASHP). Though details of the legislation vary among the states, they each serve the goal of bringing palliative care to more patients with serious, chronic, or life-limiting conditions.
Lack of awareness is a major barrier to palliative care expansion. A Journal of Palliative Medicine study, published in April, found that as many as 71% of people in the United States have little to no understanding of what palliative care is, including many clinicians in a position to refer patients to palliative care or hospice.
“I am amazed at how many people don’t know that this is a service that we offer, and once they find out it’s available they still have no idea what we actually do in palliative care. It’s just not something people are familiar with.” Laura Archuleta, M.D., palliative care medical director at North Dakota-based CHI-St. Alexius Health System, told Hospice News. “Some of our community doctors are still afraid that a referral to palliative care is the same thing as a referral to hospice, so they often don’t refer patients who are not terminal.”
Palliative care is similar to hospice in that it is non-curative care provided by an interdisciplinary team focused on symptom management and improving the patient’s quality of life. However, palliative care is not limited to those who are within six months of the end of life but can be delivered at any point in the course of the patient’s illness, concurrent with other treatments.
State palliative care laws tend to focus on four main areas, according to an NACHP report, including regulations that define, standardize, and support palliative care delivery; palliative care Medicaid reimbursement policies; integration of palliative care into public health and education programs; and engaging stakeholders to inform policies and programs.
Driving state interest in palliative care is its potential for reducing health care costs. An analysis by economic research organization Florida TaxWatch found that palliative care could reduce societal health care costs by $103 billion within the next 20 years, the nonprofit economic research group Florida TaxWatch said in a report. The group recommended that policymakers take action to expand palliative care utilization in Florida.
Palliative care saves state Medicaid programs an average of nearly $7,000 per patient annually, according to a 2011 study, particularly among those with serious illness or histories of hospitalization.
“Despite evidence that palliative care can improve patient’s care experiences and reduce cost, access to quality palliative care for these individuals remains a challenge,” the NACHP report said.