A Discussion on Palliative Care Danielle B. Scheurer, MD, MSCR Chief Quality Officer & Hospitalist April 12, 2012 – MUSC BOT Retreat

Background 5% of seriously ill Americans account for 50% of health care spending, primarily in the last year of life. Majority of patients-families report end of life unmet needs (pain, discomfort, emotional / spiritual distress, caregiver burdens). Discordance between previous wishes and actual care. Only 30% of elderly patients hospitalized at the end of life have documentation of their wishes in the medical record. Heyland DK. JAMA Intern Med. Published online April 01, doi: /jamainternmed

Background

Hospice enrollment and Medicare savings Time of hospice enrollment and savings per beneficiary (compared to non-hospice) 1-7 days before death: $2, days before death: $5, days before death: $6,500

Average Medicare Inpatient Spending in the Last 6 Months of Life

Average Medicare Outpatient Spending in the Last 6 Months of Life

Current MUSC Palliative Care Resources Inpatient Clinical Service – 1.5 FTE physician, 1.0 FTE APP – Available SW, case mgt, chaplain, ethics (not dedicated to palliative care) Interdisciplinary reviews Screening with mandatory action (pilot) Physician Order for Scope of Treatment (pilot) Education  Med Students, Residents, Nurses

Future MUSC Palliative Care Resources Palliative care fellowship – 2 fellows annually – Proposal circulating Clinic / Outpatient Service – Half day weekly on site Research – Recruiting

Challenges Culture change – Patients-Families – Physicians-Staff Community & State involvement – CAPC rates SC a “C” overall – Larger and non-for profit hospitals more likely to offer services – Non-hospital services patchy

Discussion Points Spending is very high at the end of life. Many patients-families do not receive care concordant with wishes at end of life. Early palliative care involvement is best. MUSC should be a mentor in the state on the creation and sustainment of in- outpatient palliative care services.