Access to Hospital Palliative Care Growing in United States

The availability of hospital-based palliative programs is growing nationwide, though some regions remain underserved according to new research by the Center to Advance Palliative Care (CAPC). Patients in the northeastern United States who suffer from serious illness have significantly greater access to palliative care programs that individuals in other parts of the country.

Currently 72% of hospitals in the United States with 50 or more beds have a palliative care program. This is up from 67% in 2015 and 7% in 2001, CAPC found. These institutions care for 87% of all hospitalized patients nationwide. Large nonprofit hospitals in large cities are the most likely to provide palliative care.

The report did not include data on community-based palliative care programs because only a limited amount of data are available about the prevalence of those programs, Diane Meier, M.D., executive director of CAPC, told Hospice News.

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Despite the dearth of data, there remains a tremendous need for community-based programs.

“About 45% of the home-based palliative care services — that is patients who need to get PC at home who are not eligible for hospice — are run by hospices that are delivering more than one service line,” Meier told Hospice News. “I want to encourage hospices to double down on that, because there is an enormous unmet need. And who better and who more knowledgeable than hospice professionals to extend their wonderful care to a large population of people who may live for quite a while with a burden of serious illness.”

CAPC has released a palliative care state-by-state report card that evaluates the availability of hospital-based services throughout the United States. The report updates a similar document that was released in 2015.

New England received at “A” grade from CAPC in 2019 as in 2015, but the Mid-Atlantic and east north-central areas advanced to join that region in the top tier, meaning that more than 80% of their hospitals report having a palliative care team.

Delaware, New Hampshire, Rhode Island and Vermont each reported palliative care teams in every one of their hospitals with 50 beds or more. Connecticut, South Dakota, North Dakota and Utah were each a single hospital shy of achieving 100% penetration.

“The reason that palliative care has grown so rapidly in the past 15 years is both because of the evidence of markedly improved quality of care for the most complex, high-need patients, and also because hospitals are reimbursed on a lump sum basis,” Meier said. “Medicare pays hospitals a lump sum of money for the entire hospital stay. So clearly if the hospital stay is short and sweet the hospital has some sort of a margin on that reimbursement. They have a very strong incentive to make the stay as safe as possible, to make it efficient, and to manage common complications that people with serious illness experience that can extend a hospital stay.”

The lowest performing states according to the report were Alabama, Mississippi, New Mexico, Oklahoma and Wyoming, with fewer than 40% of hospitals indicated that they had palliative care teams.

CAPC researchers also found that rural areas remain grievously underserved. Only 17% of hospitals with 50 beds or more in rural communities offer palliative care, compared with 90% of hospitals in urban areas.

“As with virtually everything in the health care system, if you live in a rural area your access to just about everything, including palliative care, is poor,” Meier said.

Interest in palliative care is growing among health care providers (including hospices), payers and policymakers due to the substantial potential savings in health care costs and the need to care for an aging population a high proportion of which suffers from serious or chronic illness.

More than 12 million adults and 400,000 pediatric patients live with serious illness in the United States, suffering as a result of conditions ranging from cancer and heart disease to dementia. By 2035, 78 million people in the United States will be older than 65, with 81% likely to suffer from more than one chronic health conditions, according to CAPC’s report.

Palliative care consultation can reduce direct hospital costs by $3,000 per patient admitted, and up to $4,800 per admission for patients suffering from four or more diagnoses.

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