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Pulling the Pieces Together

George Giokas, MD, Chief Medical Officer at Palliative Care Partners

You’ll hear a great deal about palliative care in the next few years, so let’s get two things straight: palliative care is not hospice—though the two are similar—and Hixny is perfectly positioned to play a critical role in this fast-growing specialty.

What Palliative Care is—and Why it Matters

Strictly speaking, palliative care is a multidisciplinary approach to relieving the pain, symptoms and stress associated with serious illness while improving quality of life. If anything, multidisciplinary is an understatement: teams may include palliative care doctors and nurses, social workers, spiritual care coordinators, pharmacists,
physical therapists and others, all of whom coordinate with the patient’s own healthcare team. Besides symptom management, they often help patients set care goals and make treatment decisions.

While hospice includes the same sort of care, there is one big difference. Hospice focuses on patients with terminal illnesses whose focus is primarily on comfort. Palliative care is for anyone with a serious illness, regardless of prognosis or treatment plan decisions.

While hospice includes the same sort of care, there is one big difference. Hospice focuses on patients with terminal illnesses whose focus is primarily on comfort. Palliative care is for anyone with a serious illness, regardless of prognosis or treatment plan decisions.

“There are many more people who have to cope with multiple serious illnesses and are not at the end of life,” said George Giokas, MD, Chief Medical Officer of Palliative Care Partners, a service line connected with St. Peter’s Health Partners. “They benefit from the extra support of a team to focus on relieving their symptoms, improving their quality of life and determining how treatments can best accomplish what matters most to them. In this way, palliative care can have a real effect on the patient experience.”

A growing body of evidence demonstrates that palliative care not only benefits patients and families but lowers healthcare costs. In various studies, palliative care reduced emergency department (ED) visits by 30 percent, lowered total hospital days by 60 percent, made readmissions more unlikely, improved patients’ satisfaction with many aspects of their care and even increased patients’ lifespans.

Change on Many Fronts

With these benefits, it’s no wonder that organizations from across the healthcare spectrum are getting on board. To take one example, the number of large U.S. hospitals (more than 50 beds) with a palliative care team has nearly tripled in just 12 years, from 658 in 2000 to over 1,700 in 2013, according to the Center to Advance Palliative Care.

“Previously, hospitals would assess their lines of business in terms of revenue generation, and palliative care was not a revenue generator,” observed Ned Jaleel, DO, Medical Director at Capital District Physicians’ Health Plan (CDPHP). “If they had a bad quarter, they’d cut their palliative care programs. But now more hospitals are taking a different perspective. They want to decrease admissions, length of stay and other cost parameters—so more and more of them are offering palliative care.”

While most payers, including Medicare and Medicaid, cover at least some palliative care services when delivered in hospitals or hospice care, there’s still a need to extend coverage to patients in homes and community-based settings. A small but growing number of insurers are doing just that, according to an article on the Pew Charitable Trusts website. CDPHP may soon join their ranks, said Jaleel, having just launched a pilot project to cover home health palliative care.

“Home health teams are in a great position not only to provide care, but to identify people who could benefit from palliative care and then provide their doctors with valuable feedback. We need a lower threshold for getting palliative care to these patients.”

Diane Pickering, RN, can attest to that. At Advanced Illness Management of St. Lawrence Valley, where she serves as Director, nearly all services are delivered at patients’ homes. This represents a considerable shift in the organization's original focus on providing palliative care in an office environment.

“We’re serving a lot of people with multiple chronic diseases,” Pickering explained, “many of whom are shut-ins. The idea of visiting yet one more building for their care, especially in a county as large as this, can be overwhelming. And we want to see patients at home: it gives us an idea of what they’re dealing with.
We can use that to guide our conversations with them and make better decisions.”

Government is starting to support the cause of palliative care as well. According to the Pew article, several states now require physicians, hospitals and nursing facilities to provide information on palliative care to patients with certain serious illnesses. In New York State, the Palliative Care Access Act goes one step further, requiring not only information but also that providers “facilitate access to appropriate palliative care consultation and services.”

For Elizabeth Kirby Walsh, the Manager of Palliative Care Partners, current trends in healthcare make palliative care particularly relevant now. “The time is right for palliative care, especially given today’s focus on population health,” she said. “Both focus on making care more available to more people, earlier in the disease process.”

“The time is right for palliative care, especially given today’s focus on population health.” —Elizabeth Kirby Walsh, Manager at Palliative Care Partners

Hixny: Critical to Palliative Care

Just as in other healthcare specialties, the success or failure of palliative care rests on precise, accurate and timely information. Here Hixny is ideally positioned to support the healthcare community in its service area.

“Our patients typically see so many providers as part of their care,” observed Pickering, whose North Country agency receives notifications from Hixny of their patients’ medical events, especially ED visits and hospital admissions. “We appreciate notifications from Hixny so we don’t walk in blind—not knowing, for instance, that the patient had just been in the hospital for two weeks.”

“Everyone has this same issue. A patient may see his primary care provider and his cardiologist and his pulmonologist, and no one has a full picture of the patient. Hixny helps provide that by closing the communication gap between providers.”

For Walsh, Hixny’s common platform becomes even more important nowadays, as palliative care spreads. “Given that we’re expanding to different settings, wouldn’t it be great if providers had the ability to track what’s happened with the patient to date, in terms of both palliative care received and the conversations surrounding it?” she said. “Hixny enables providers to do that.”

Hixny patient records can potentially hold one of the cornerstones for a palliative care team: advance directives. A dedicated field in the Hixny database allows providers to note the existence and content of such directives, noted Tavia Rauch, Hixny’s Manager of Population Health & Data Quality. “Hixny is the ideal repository for advance directives, because every member of the care team can access them at any time,” she said. “In addition, patients can change them as they see fit and as their situation develops.”

Hixny’s emphasis on data completeness not only makes it invaluable for population health, but also enhances payers’ ability to design new and better palliative care coverage. “At CDPHP, we’d love to be entirely reliant on Hixny, using it from soup to nuts on palliative care,” Jaleel said. “CDPHP has a great analytics team, but we’re limited in that we just have claims data—and it’s impossible for claims data alone to give us a 360-degree view of the situation. With all the data it has, Hixny can be huge for us.”

Elizabeth Kirby Walsh, Manager at Palliative Care Partners

Palliative Care: Critical to Patients

Hixny can make a major impact in a fastgrowing specialty that makes a difference in the lives of patients. How big a difference? Catherine Adams, MD, a palliative care physician at St. Peter’s Health Partners, has seen it firsthand.

“One of my patients was a very active gentleman in his late eighties who developed kidney failure and had started on dialysis,” she said. “He had come to the hospital with terrible back pain which he felt wasn’t being addressed; as a result, he had started to refuse dialysis, knowing that this would end his life. We talked about what gave his life meaning and engaged his large family in discussions about how some of his goals could be achieved. We worked on treating his back pain and increasing his mobility. Eventually, he decided to resume dialysis, knowing that he would have to make some modifications to his prior lifestyle, but feeling that he could find new ways to enjoy life and the outdoors with the support of his friends and family.”