Two states — Massachusetts and Oregon — rise above the rest when it comes to access to palliative care.
This is according to the new rankings from the Center to Advance Palliative Care, America’s Readiness to Meet the Needs of People with Serious Illness Scorecard. The scorecard ranks each state’s capacity to deliver high-quality care to people facing serious illness on a five-star scale by evaluating five domains, according to Stacie Sinclair, the associate director for policy and care transformation at the Center to Advance Palliative Care (CAPC).
To develop the scorecard, CAPC applied an updated methodology that considers metrics beyond those used in previous reports, which only examined the availability of palliative care in hospitals with 50 beds or more.
“The breadth of the scores that were awarded to states using the new methodology just demonstrates that there’s a ton of opportunity to advance care for people with serious illness at the state level,” CAPC CEO Brynn Bowman told Palliative Care News. “The updated methodology includes access to specialty palliative care, payment for palliative care services, the structures and coalitions in place to advocate at the state level, clinical skills building and then other kinds of state level resources for patients and caregivers.”
No states achieved a five-star rating. However, Massachusetts and Oregon received the highest marks at 4.5 stars. Six states achieved a four-star rating, California, Connecticut, Illinois, Maryland, New Jersey and Ohio. Twenty-nine states and the District of Columbia reached between 2.5 and 3.5 stars, and 13 received two or fewer, according to CAPC.
The research behind the scorecard also found that “stark health inequities” exist based on race and income. Black Americans, for example, are at the highest risk of death due to cancer and heart disease, but less likely to receive appropriate symptom management, the research found.
Among hospitals, 83.6% in the United States with 50 beds or more report having specialty palliative care services. However, the proportion of for-profit hospitals and rural hospitals with palliative care lags behind significantly, at 49.0% and 34.5% respectively, CAPC reported.
Only 13 states currently require payment for palliative care services via Medicaid or other sources.
CAPC also found:
- The number of specialty-trained palliative care clinicians lags behind that of most other specialists, with 19,920 specialists across all disciplines in the United States with specialty certification in hospice and palliative care.
- Increasing numbers of clinicians are gaining basic skills in key drivers of palliative care outcomes, including communication and symptom management. Some states have included continuing education mandates in licensure requirements, and others have incorporated palliative care content into medical and nursing board opioid training standards.
The results show improvement in palliative care access over time, according to Sinclair.
“No states have scored a zero. Every state has done something, and part of the impetus for this is to create more nuance in how we measure progress, to reflect the hard work that champions in every state have done,” Sinclair told Palliative Care News. “Our hope is that the scorecard and the individual state reports give them more information to decide what makes sense for them to do next.”
