Palliative care can be valuable for heart failure patients and may lower the risk of hospital readmissions, according to a recent report from the American Heart Association (AHA). With circulatory/heart conditions among the most common diagnoses for hospice patients, providers could benefit from incorporating palliative care into their service lines.
The AHA report stated that the prevalence of heart failure will continue to grow, resulting in millions with the condition by 2030. Congestive heart failure and other cardiac illnesses are among the leading diagnoses of hospice patients. In 2017, nearly 195,000 (roughly 18%) of hospice patients receiving Medicare died of heart failure, according to a report from the National Hospice and Palliative Care Organization (NHPCO).
Reaching heart failure patients with expanded palliative care services could benefit hospice providers working to protect these patients who are at the highest risk of developing severe symptoms and death resulting from the novel coronavirus pandemic.
“There is a misunderstanding about when palliative care would be beneficial,” said James Rudolph, M.D., of Brown University, who co-authored the AHA study. “There’s a perception that it’s provided only at the very end of life, and that’s not true. Palliative care added to heart failure treatment plans, especially when a patient is hospitalized, can have a big impact on the patient and the entire health system.”
Hospices provide about 50% of home-based palliative care in the United States according to the Center to Advance Palliative Care, and the number of providers that are diversifying their services lines to include palliative care continues to increase.
Since heart failure patients experience a range of symptoms that can impact daily life and cause increased suffering and risk of death, hospice providers expanding into palliative care for these patients could improve their overall quality of care with a focus on pain relief, emotional support, treatment and therapies that are not limited to end-of-life care.
AHA researchers found that heart failure patients receiving palliative care experienced fewer rehospitalizations than those who did not over a six-month period following discharge for procedures such as mechanical ventilation and defibrillator or pacemaker implantation. The study indicated that palliative care reduced the chance of hospital readmission or being put on mechanical ventilation by about 25%.
Hospices have increasingly focused on reducing hospitalizations, working within value-based payment models in anticipation of the Medicare Advantage hospice carve-in set to begin January 2021 under the U.S. Centers for Medicare & Medicaid Services’ new Primary Care First Initiative. Utilizing hospice and palliative care has been associated with reduced hospitalization, which is a primary objective for the program, as well as reduced costs and improved care coordination.
Reduced hospitalizations can in turn lead to decreased overall health care costs and result in patients in need of hospice coming onto service earlier in their illness trajectory.
Community-based palliative care can reduce total health care costs by 36%, a Turn-Key Health paper indicated last year. These services can also reduce hospital admissions by 48%, resulting in 28% cost savings per patient day. In the outpatient setting, community-based palliative care has been shown to reduce emergency department visits by 35%.Home-based 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 2019 report.