NCP Guidelines: Domain 1 - Structure and Processes of Care
December 8, 2018
We Need Community-based Palliative Care Now
January 3, 2016
I need a community-based palliative care program (CBPC) for my mother. She needs ongoing care coordination, regular assessments and medication reconciliation. Since I live hundreds of miles away, I need a skilled palliative care team to help me, so I'm not relying solely on her reports to monitor her care and status.
A year ago I wondered if 2015 would be the year of CBPC. Now I need 2016 to be the year that CBPC is available for my mom - and all our relatives, friends and neighbors who need it. People with one or more serious or chronic conditions need CBPC before they experience a crisis.
My wish / to do list for 2016:
#1 Develop a standard mechanism for triggering a palliative care consult that works in facilities, physician offices, community-based care providers and that payers can integrate into their care management protocols.
All of my clients who have or are creating a palliative care program use different triggers for palliative care. That makes sense, since each palliative care program has defined their specific patient population. That being said, there are universal indicators that palliative care programs include within their trigger mechanisms:
Pain and symptom management
Support regarding complex decision making
Psychological and/or spiritual support for patients and families
Hospitalizations within a certain period of time
In my ideal world (if only I were queen), specific general palliative care consultation triggers would be built into electronic medical records, so that patients in all care settings who meet these criteria would be flagged for a consult.
Since I'm not queen of the world, we can start by identifying specific palliative care consult criteria and encouraging every new and operational palliative care program to use these standard triggers.
Is anyone working on this?
What triggers should be included?
Most importantly, how can we move this forward?
Population health models, such as the one offered by Turn-Key Health, utilize predictive analytics to identify patients before a crisis. This approach identifies patient at risk for receiving unwanted and medically unnecessary care, to ensure the patient receives a referral to a palliative care program.
#2 Train more clinicians to be palliative care specialists.
#3 Train all clinicians to recognize the value of partnering with palliative care as well as when and how to refer patients to CBPC.
This is huge. In fact, I think it's more important at this point than training specialists. Too many patients including, my mom, are getting sub-par care because physicians and other providers do not recognize the value of palliative care. We can build palliative care programs 'til the cows come home, but until we have more generalist palliative care providers, the majority of people won't receive palliative care in time to prevent a crisis, if at all.
As I mentioned in an earlier post, I was fortunate to be able to work with the CSU Institute for Palliative Care to develop a series of courses designed to training everyone in the basics of palliative care. If you want to train more people in basic palliative care, whether they work for you or are potential referral sources, take a look at these courses.
#4 Teach and support more hospice and other community-based providers to develop and deliver cost-effective CBPC.
The seemingly insurmountable challenge often lies with finding partners who will pay for the CBPC palliative care services. Fee-for-service Medicare cannot sustain a comprehensive palliative care program. Turn-Key Health is helping CBPC programs develop these partnerships, so that CBPC programs can receive comprehensive reimbursement and payers can ensure patients at risk for a healthcare crisis receive in-home palliative care.
#5 Disseminate models to improve the clinical and financial efficacy of CBPC, including the use of technology to deliver more cost effective care coordination. There are so many great models that are emerging to provide high quality CBPC to patients in all settings.
ResolutionCare, along with other care providers, are using telemedicine technology to provide virtual patient visits and consultations. Providers across the country are integrating readily-available technology such as Skype and FaceTime to talk with patients and caregivers between in-home visits. This reduces staff costs by triaging the need for in-home visits.
Wouldn't it be great to have these and other CBPC care delivery models housed in one online library so we could find easily find and replicate them? The California HeathCare Foundation's CBPC Resource Center could be expanded to include even more resources from across the country.
And perhaps most importantly...
Identify national champions who will work together to lead a unified effort to achieve these goals.
My biggest wish for 2016 is that the leaders of the "big dog" associations and organizations can work together on these and other projects that can improve availability of CBPC across the country. Palliative care or advanced care -- no matter what we call it, we're all working to ensure everyone has access to CBPC when and where they need it.
What's on your palliative care wish list for 2016? Tweet your ideas - #CBPCwishes or email me.
Let's work together to make it happen!
Wishing you and your family a very happy new year. kb