Palliative Care and Hospice: Understanding the Differences Part 2
In response to many inquiries about the difference between hospice and palliative care, we are taking this opportunity to provide information in our Blog.
- Part I provided an overview of the differences and more closely defines hospice care. Click here to read it.
- Part II examines palliative care in greater detail
A Closer Look at Palliative Care
Palliative care — a term that comes from the Latin word palliare (to cloak) — is different from hospice in that caregivers treat the side effects of intensive care and serious illness, whether a patient is fighting the illness or has chosen to forgo treatment. It’s not necessarily end-of-life care. In contrast, hospices use palliative care because there’s a larger population of Americans with long-term chronic and serious illness who need more help than a typical primary care practice can offer.
Who Can Benefit?
Palliative care is appropriate for patients of any age and in all disease stages, including those undergoing treatment for curable illnesses, those living with chronic diseases and those who are nearing the end of life.
Palliative care programs can be offered to any patient without restriction as to disease or prognosis. It may be appropriate for anyone with a serious, advanced illness, whether they are expected to recover fully, to live with chronic illness for an extended time or to experience disease progression.
Palliative care focuses on improving life and providing comfort to people of all ages who have advanced illness. This may include cancer, congestive heart failure, End Stage Renal Disease, chronic obstructive pulmonary disease, HIV/AIDS and Alzheimer’s disease, among others.
Focus of Care
This level of care focuses on symptoms, such as pain, shortness of breath, fatigue, constipation, nausea, loss of appetite, difficulty sleeping and depression. It also helps patients gain the strength to carry on with daily life and tolerate medical treatments. In addition, it empowers them to have more control over their care by improving communication so that they can better understand their choices for treatment.
Costs are offset by fewer trips to emergency departments and fewer hospitalizations, and stakeholder ratings are positive. This explains why 80 percent of hospitals with 50 beds or more have established palliative care teams, often based in the intensive care unit, and some are starting to consider outpatient palliative care programs.
Matching Care to Personal Goals of Treatment
Palliative care programs and advance care planning that include earlier conversations about patient and family goals of care are consistently demonstrating their value in helping patients live their final days in accordance with their wishes. Data shows that in communities that provide greater access to palliative care programs, patients are less likely to die in the hospital. Furthermore, findings show that they experience fewer admissions to the intensive care unit in the last six months of life, have fewer intensive care admissions during terminal hospitalizations and spend less time in an intensive care unit in the last six months of life.
The issue is that palliative care programs struggle financially because there is no reimbursement code specifically for palliative care. Hospital-based palliative care is paid by the health system with some FFS billing for physician services. Physician and nurse practitioner fees are covered by Medicare Part B for inpatient or outpatient care. Hospital teams are included within Medicare Part A or commercial insurance payments to hospitals for care episodes. Palliative care is also paid for through flexible bundled payments under Medicare Advantage, Managed Medicaid, ACOs, and other commercial payers.
While Medicare doesn’t have a palliative care benefit, CMS has authorized demonstration projects that are testing different ways of meeting the needs of seriously ill patients. The Medicare Care Choices Model allows patients to receive hospice-like support services while concurrently being treated for their illness.
A Preferred Option for People Facing Advanced Illness
Today, palliative care is becoming a preferred option at any stage of advanced illness, not simply reserved for care at the end-stage of life. Its use should be driven by patient need, not disease prognosis. Many thought leaders regard palliative care as a key to the future of healthcare.