United States Ranks Low in Palliative Care Duration

The average length that patients receive palliative care in the United States is lower than in other countries, a recent study reported. Much of the nation remains underserved despite rising demand, with limited payment opportunities restricting growth.

A review of palliative services delivered worldwide indicated a wide variation in length of care received by people with life-limiting and terminal conditions. Researchers analyzed nearly 12 million cases across 23 countries. The researchers are based at the University of Leeds’ Academic Unit of Palliative Care in the United Kingdom, and included researchers from the Hull York Medical School and the Department of Public Health and Primary Care at Ghent University in Belgium. It was supported by the National Institute for Health Research Infrastructure at Leeds.

The comparison of data spanning five years from 2013 to 2018 found the overall global average duration of palliative care was roughly 19 days. This average falls short of the three- to four-month period for these services to be most impactful in improving quality of life and reducing costs of care for patients and their families, according to the study.

“Our work highlights a stark shortfall in the duration of palliative care being provided internationally,” said study co-author, Matthew Allsop, university academic fellow from the Leeds Institute of Health Services. “There is a clear and significant gap between current and ideal practice, which impacts on the benefit of palliative care for patients and health care services. Globally, palliative care needs to be highlighted as an essential component of health care with efforts needed to increase capacity and access to support for patients and their families.”

Early integration of palliative care can reduce high costs associated with emergency health services and alleviate suffering due to serious illness for those approaching the end of life. Some countries lag far behind others in supporting patients who could benefit from these services, according to the research.

Canada held the longest length of palliative care duration with an average of 69 days, while Australia fared the shortest duration at six days. Patients in the United States received an average of 10 days less than those in other countries, even though the nation ranks high internationally when it comes to overall access.

This disparity indicates a growing need to address barriers and inequities in access, with funding playing a large role in the United States’ lag. The study’s findings suggest that the nation’s payment structure for palliative care, typically through Medicare fee-for-service programs, may be a contributing factor. The requirement that patients must forgo curative treatment in order to receive hospice care could also play a role, according to this new research.

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.

Some hospices have worked to develop payment opportunities that go beyond Medicare fee-for-service, including private payer contracts, partnerships with hospitals or other providers, philanthropic support and arrangements with Accountable Care Organizations or Medicare Shared Savings Plans.

The U.S. Centers for Medicare & Medicaid Services (CMS) as of 2019 has allowed Medicare Advantage plans to offer palliative care as a supplemental benefit. According to an analysis by ATI Advisory, 61 health plans nationwide are offering in-home palliative care as a benefit this year. This is up from 29 in 2019. More than 455,000 beneficiaries are enrolled in these plans. However, the availability of these plans remains limited geographically.

Evolving payment models may be an avenue for further palliative care integration into the hospice space as providers seek to diversify and expand these services in coming years. Demand for palliative care is expected to rise worldwide over the next four decades, partly due to a swelling aging population.

“The global burden of serious health-related suffering requiring palliative care is projected to almost double by 2060,” said Allsop. “Increased funding is essential to develop capacity, but so too is research, to determine when people are accessing palliative care how existing services can be improved.”