Access to palliative care and hospice reduces aggressive treatments among seriously ill patients that they neither desire nor benefit from.1, 2 However, these services—which focus on providing comfort, psychosocial support and symptom management—are frequently underutilized.1, 2 As the largest Awardee Convener in the Bundled Payments for Care Improvement (BPCI) initiative, Remedy Partners has developed a set of resources to advance the appropriate use of palliative care and hospice as this is a critically important aspect of care for patients experiencing acute or exacerbated chronic illness.
To promote the appropriate use of palliative care and hospice, successful healthcare organizations couple provider education with robust processes that facilitate the use of these services. Remedy Partners supports our partners by providing tools that assist with patient identification, designing incentive plans that encourage physicians to discuss serious illness and care goals with patients, connecting our partners with providers of palliative and hospice services to promote easy referrals, and offering analytics to measure opportunity and changes in these services’ utilization.
In order to encourage providers to consider palliative care and hospice when appropriate, Remedy Partners has embedded relevant prompts into our tools and resources. This includes the “surprise” question: Would you be surprised if this patient died within the next year? This simple question can be effective in predicting patient mortality, so we’ve incorporated it into our patient tracking software, Episode Connect. If the provider answers “no,” she is prompted to consider a palliative care or hospice consult.
We are also leveraging machine learning techniques to develop a mortality predictor that will flag patients who are likely to be approaching the end of their life. Recognizing that conversations around care goals can occur at different stages of a patient’s episode, we’ve integrated cues to consider palliative care or hospice into our workflows and discussion guides around Next Site of Care selection in the acute setting and our condition-specific Skilled Nursing Facility Care Guidelines.
Finally, we’ve worked with partners to implement customized processes to support their unique needs around the use of palliative care and hospice. At one national partner system, we helped design an incentive program to encourage physicians to conduct advance care planning conversations with appropriate patients. We’re helping other healthcare systems develop partnerships with national hospice providers to make it easier for their physicians to connect patients to the services they need. Additionally, we’ve generated reports for select partners showing their utilization rates for palliative care and hospice to enable them to track the impact of their efforts.
Optimizing the use of palliative care and hospice requires a multi-pronged approach combining provider education and supporting processes. Remedy Partners’ publications, Episode Connect software, clinical tools and expertise are helping our partners advance their efforts to deliver the best possible care to patients with life-limiting illness.
Many of the resources, publications and education mentioned above are offered through our Transitional Care Institute, or TCI. This website features an end of life care order set, a list of Physician Orders for Life Sustaining Treatment resources by state, and several brief papers and blog posts on the importance of palliative care and hospice. Our public webinar on hospice and palliative care can be accessed here. Additionally, Remedy Partners has strong relationships with experts in the field; for example, Dr. Steve Pantilat, a national expert on palliative care, has been a keynote speaker at each of our last three National Innovation Collaboratives. Finally, our clinician experts deliver targeted education to our partners’ frontline providers. Be sure to visit http://blog.remedypartners.com/ to learn more.
1. Diane E. Meier, Anthony L. Back, Amy Berman, Susan D. Block, Janet M. Corrigan and R. Sean Morrison. “A National Strategy For Palliative Care.” Health Affairs 36, no.7 (2017):1265-1273.
2. Kuldeep N. Yadav, Nicole B. Gabler, Elizabeth Cooney, Saida Kent, Jennifer Kim, Nicole Herbst, Adjoa Mante, Scott D. Halpern and Katherine R. Courtright. “Approximately One In Three US Adults Completes Any Type Of Advance Directive For End-Of-Life Care.” Health Affairs 36, no.7 (2017):1244-1251.