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Palliative care can lower cost and bridge transitions and conversations

Editor’s note: This article was written by guest blogger Anthony Cirillo, FACHE, ABC, a healthcare marketing and experience management expert and expert guide in assisted living for about.com. For more information about the author, please see our About page.

We hear so much about lowering costs in healthcare today. And yet:

  • 93% of physicians practice defensive medicine, ordering diagnostic tests, referring to other specialists, and prescribing medications
  • 28% of Medicare spending occurs in the final year of life; 12% occurs during the final two months
  • 38 states have obesity rates over 25%; 42 states have diabetes rates over 7%; one in five adults smoke cigarettes adding $100 billion of healthcare cost

We can argue malpractice reform, personal responsibility, and all of that. But we also have to learn to use what we have. And perhaps palliative care can help.

According to presenters at the Governance Institute, implementing a first-class palliative care program can cut costs and provide better quality of life not just for the dying but also those with chronic conditions and serious illness. Using palliative care saves the healthcare system $1,700 per discharged patient.

Waste in medical services is currently estimated at 20% to 35% of total healthcare spending. The following contribute to waste:

  • Services necessitated by incorrect and/or unsafe practices
  • The use of unproductive or counterproductive interventions
  • Failure to use the least-expensive appropriate resources
  • Redundant reimbursement

The argument was made that we must have a worldview of palliative care as comprehensive, interdisciplinary care focusing on promoting quality of life. In fact palliative care is the best way to have important conversations with patients and families about the right level of care given the expected outcome.

Of course we are reimbursed in a fee-for-service environment and until the shift to wellness and bundled payments takes place, there is little incentive for providers to change their ways. Yet perhaps if we realize that this could be in the best interests of the patient and truly embrace person-centered care, providers would change.

I think patients know what is right for them and I think families intervene. That is why programs such as Engage With Grace: The One Slide Project are important. It poses five questions designed to help get us talking with each other and with our loved ones about our preferences.

Most people do not die according to their wishes. And they should. That is why they need to put it in writing. And that is where another resource, Five Wishes, comes in.

It lets your family and doctors know:

Who you want to make healthcare decisions for you when you can’t make them
The kind of medical treatment you want or don’t want
How comfortable you want to be
How you want people to treat you
What you want your loved ones to know

Five Wishes has become America’s most popular living will because it is written in everyday language and helps start and structure important conversations about care in times of serious illness.

If we truly put people at the center of care we will embrace alternative care methods such as palliative care and start discussing death and dying in this culture and not avoid it. It is ultimately about quality of life at the end of life.

And providers play a role.