I have posted previous notes about the topic of palliative care services in hospitals (see: Aggressive Care, Not Palliative Care, the Norm in New York Academic Hospitals; Impressive Growth in Hospital-Based Palliative Care Teams). I had previously been under the impression that hospitals were deploying palliative care teams primarily because of quality concerns and that the cost of them was on the negative side of the ledger. However, a recent article got me thinking that there may actually be cost savings associated with palliative care (see: Death With Dignity Why is dying at home more the exception than the rule?). Below is a quote from Dr. Michael Levy from this article;
"The main reason for the current interest in palliative care by hospitals and healthcare systems is its potential to reduce healthcare costs by de-escalating expensive, futile, aggressive care, preventing the escalation of care to expensive, futile, aggressive care, and by reducing 30-day readmission rates. The net result of this tumultuous development of palliative care as a welcomed approach to optimize how patients live until they die, is a shortage in trained, certified, palliative care professionals and delivery models and an incomplete integration of palliative care into our healthcare delivery system. Ideally, palliative care should be offered at the beginning of life-threatening illness and not wait until the end. Even if there were enough palliative care available to care for all the patients that need it, many physicians still view it as something less than hopeful and valuable to offer to patients than continuing to fight their disease.
A lot of wisdom is contained in this very short passage. First of all, palliative care, in addition to being a a very humane approach to the care of patients with terminal diseases, can also help to "de-escalate expensive, futile, and aggressive care" and, in so doing reduce the cost of care. The second important point is that there is a shortage of certified, trained and certified professionals in this area so resources need to be expended to expand this pool. The third important point is that a barrier to effective palliative care is "[its] incomplete integration...into our health delivery system." The conclusion that a very sick patient needs the attention of the hospital palliative care team may not always come easily to the physicians caring for him or her. Physicians are trained to provide aggressive care to the end and this is probably what many patients are also seeking.
Adding to all of this discussion is that the scope of palliative care is now expanding. Here's a quote from the the Wikipedia article on palliative care: "The term "palliative care" is increasingly used with regard to diseases other than cancer such as chronic, progressive pulmonary disorders, renal disease, chronic heart failure, HIV/AIDS and progressive neurological conditions. In addition, the rapidly growing field of pediatric palliative care has clearly shown the need for services geared specifically for children with serious illness (see: Palliative care)."