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

2. 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. http://content.healthaffairs.org/content/32/3/552.full.html Heyland DK. JAMA Intern Med. Published online April 01, 2013. doi:10.1001/jamainternmed.2013.180

3. Background

6. Hospice enrollment and Medicare savings Time of hospice enrollment and savings per beneficiary (compared to non-hospice) 1-7 days before death: $2,500 8-14 days before death: $5,000 15-30 days before death: $6,500 http://content.healthaffairs.org/content/32/3/552.full.html

9. Average Medicare Inpatient Spending in the Last 6 Months of Life

10. Average Medicare Outpatient Spending in the Last 6 Months of Life

11. http://www.capc.org/reportcard/home/SC/RC/South%20Carolina

13. 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

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

15. 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

16. 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.