Week 13: 4/11-4/17-Sustaining and Funding Innovation

So far in this blog we have examined the historical and contemporary issues revolving around palliative care and H.R. 3119. Today, for the final post we are going to move into the future to explore how these policy changes can be funded and sustained. The sustainable perspective of this policy is partially built into the foundation of the bill. Because the bill seeks to improve research and educate health care workers at the university level it sets itself up for long term success (1). By reaching physicians, nurse, etc at the base of education, those individuals can be expected to carry the information with them throughout their careers while simultaneously sharing and educating others. The gumption supporting the inclusion of palliative focused education in schools is partially dependent on the financial incentives suggested by H.R. 3119.(1). Having continued financial support optimizes the chance that schools will adopt palliative programs and maintain these programs over time. Similarly, palliative care research is an investment that will pay off in the long run. By taking the time and resources now, we can expect to find new information and evidence that can be translated to practice to maximize the positive outcomes for those experiencing chronic illnesses.

That being said, the long term financial infrastructure supporting the bill is not as apparent. H.R. 3119 stipulates additional funding for palliative care research as well as grants provided to institutions and individuals to promote palliative care education and application (1). Thus, the financial implications of the legislation are imperative to examine. In regards to the allocation of finances to additional research, the bill does specify that this action will merely utilize existing funds and simply direct the National Institute of Health to conduct more extensive research on the topic (2). However, the allocation of funds for grants would require additional funding not currently in existence. For both aspects of the bill, the determination for funding is influenced heavily by the Congressional Budget Office. This nonpartisan organization produces “independent analyses of budgetary and economic issues to support the Congressional budget process” (3). Additionally, the CBO formulates probable financial estimates associated with legislation currently navigating the political process (3). Because H.R. 3119 remains in the committee phase of the process, its financial analysis has not yet been completed by the CBO. While palliative care is an issue that is imperative to address, there are a multitude of other health concerns that are also seeking increased funding and resources. In 2013, 17.4% of the GDP was allocated for health care and this number is expected to climb to 19.6% by the year 2024 (4). Because of the significant number of needed health changes, it is imperative to establish potential financial benefits that can be presented to policy makers.

The healthcare spending portion of the GDP continues to climb

As previously eluded to, the optimization of palliative care in the clinical setting holds the possibility of significant cost savings long term which will ultimately relieve some financial burden on the health care system. Revisiting statistics previously cited in this blog, we recall that 2/3 of Medicare expenditure goes to those with chronic illness and 25% of all Medicare spending is utilized for individuals in the last year of life (S. Winn-McCorkle, personal communication, February 22, 2016; 5). With the addition of palliative care, time spent in intensive care units and number of hospital readmissions have been shown to decrease (S. Winn-McCorkle, personal communication, February 22, 2016). Because palliative care focuses on symptom management that is guided by the individual; unnecessary tests, medications, and overall costs are reduced (S. Winn-McCorkle, personal communication, February 22, 2016). Furthermore, “Patients who received palliative care incurred $6,900 less in hospital costs during a given admission than a matched group who received usual care” (6). Focusing on long-term financial stability, with the investment of funds up front, policy makers can expect to see long term cost savings in addition to the positive outcomes regarding quality of life.

Photo Credits (in order of appearance)

  1. https://www.differencecard.com/FSAAccounts/Healthcare
  2. http://www.shockmd.com/2009/03/12/when-to-make-powerpoint-slides-available-to-students/
  3. http://healthaffairs.org/blog/2011/09/19/a-brief-history-of-health-spending-since-1965/
  4. http://www.news957.com/2016/02/25/federal-government-to-receive-report-on-physician-assisted-dying-thursday/

References:

  1. (2016). H.R. 3119: Palliative care and hospice education and training act. Retrieved from https://www.govtrack.us/congress/bills/114/hr3119
  2. American Cancer Society Cancer Action Network. (2015). Palliative care and hospice education and training act, H.R. 3119. Retrieved from http://www.acscan.org/content/wp-content/uploads/2013/11/PCHETA-bill-summary-HR-3119.pdf
  3. Congressional Budget Office. (2016). Overview of CBO. Retrieved from https://www.cbo.gov/about/overview
  4. Centers for Medicare and Medicaid Services. (2015). National health expenditure projections 2014-2024: Forecast summary. Retrieved from https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/proj2014.pdf
  5. Kaiser Family Foundation (KFF). (2015).10 FAQs: Medicare’s role in end-of-life care. Retrieved from http://kff.org/medicare/fact-sheet/10-faqs-medicares-role-in-end-of-life-care/
  6. Morrison, S., Dietrich, J., Ladwig, S., Quill, T., Sacco, J., Tangeman, J. & Meier, D. E. (2011). Palliative care consultation teams cut hospital costs for Medicaid beneficiaries. Health Affairs, 30(3), 454-463.
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Week 11: 3/28-4/3- Technology and Palliative Care

The need for palliative care has been highlighted throughout this blog, primarily focusing on the quality of life and cost savings perspectives. It is also essential to examine the palliative care provider shortage and how technology is advancing to address this problem as it continues to grow with the impending “silver tsunami.” For example, in California, only 0.9% of all physicians and 0.3% of nurses are certified in palliative care (1). When examined in the context of the needs of the population and comprehensive nature of palliative care, it is clear that technological solutions are needed.

Some general systems currently being used and researched include “remote monitoring devices, telephone, videoteleconferencing (VTC), and mobile devices” (1). Within these umbrellas, providers are able to deliver “out-of-hours telephone support, advice services, […] consultations, and assessments” (2). The discussion on these technological advances is a blog in of itself, but in general these programs allow patients to have access to their provider and other health services remotely. Many telehealth systems allow providers to serve a greater number of patients and meet the needs of patients who struggle to travel to clinics for evaluation (1).

close up of male doctor holding smartphone with medical app
Technology may hold the key to the future of palliative medicine

A specific technological innovation that may be a significant game changer for palliative care is known as EIR (3). I wanted to highlight this tool specifically as it aims to address pain which is one of the most significant symptoms managed by palliative care and of personal interest to me and my doctoral project. The EIR software is used for pain monitoring and management (2). It serves the function of supplying the provider with a “summary of the patient’s condition along with suggestions for further investigation and recommended treatment” (3). The software is comprised of medical guidelines and information entered manually by the patient (3). By combining all of the information into one program, researchers hope to optimize symptom management and longevity of life (3).

EIR.jpg
EIR advances the way providers manage pain

Because of the lack of provider education in the field of palliative medicine, technology has and will continue to serve as a medium to expand the number of providers being trained on palliative care. Through applications and software, health care professionals have improved access to palliative care education and training (3). An example of a project actively using technology to educate health providers on palliative care is Project ECHO (1). The project aims to increase the number of individuals trained in palliative care to decrease the provider shortage in this specialty (1). Similarly, technology can increase research in the area of palliative medicine. Technology allows researchers to gather data and monitor outcomes in the palliative care population (4).

ECHo
The ECHO Project uses technology to increase palliative care training and education

Some challenges met with advent of many of these technologies include concerns over privacy, security, and ease of use (2).  Privacy and confidentiality are always a concern as technology can serve as possible break in the system, potentially exposing important and sensitive health information. As technology continues to advance, it is crucial that necessary precautions are always taken to ensure that information is encrypted and secure, minimizing the risk of information breaches (2).  Furthermore, devices and programs need to have interfaces that are simple to learn to meet the needs of an already overburdened population (2). With the increase in technology’s presence in palliative care, it is also important to take a step back to address the issue of who is able to access and use these technologies. Lower income and vulnerable populations are less likely to have computer, tablets, smart phones, etc and therefore may not have access to the varying degrees of telemedicine (2). This of course further expands health disparities already burdening our communities (2). Finally, there is consistently a concern voiced over the “depersonalization” of care with the use of health technologies. These concerns are important for providers to address and ensure that they are still spending one-on-one time with patients in conjunction with touching base via telehealth.

2015-04-29-mhealth-implementation-obstacles.png

Photo Credits (in order of appearance):

  1. https://gr-wordpress.s3.amazonaws.com/2014/05/telemedicine-Grand-Rounds-Health.png
  2. http://www.mesothelioma.com/images/blog/posts/Technology_for_Cancer.jpg
  3. https://www.ntnu.edu/news/2012-news/palliative-care-congress
  4. http://echo.unm.edu/
  5. http://wac.1a76d.edgecastcdn.net/801A76D/mhealth/images/site/articles/2015-04-29-mhealth-implementation-obstacles.png

References:

  1. Ayers, K. J. (2015). Innovative use of technology for palliative care. Retrieved from http://www.onclive.com/web-exclusives/innovative-use-of-technology-for-palliative-care/1
  2. Reis, A., Pedrosa, A., Dourado, M., & Reis, C. (2013). Information and communication technologies in long-term and palliative care. Procedia Technology, 9(2013), 1303-1312. doi: 10.1016/j-protcy.2013.12.146.
  3. Norwegian University of Science and Technology. (2012). Palliative care congress showcases cutting edge technology. Retrieved from https://www.ntnu.edu/news/2012-news/palliative-care-congress
  4. Kamal, A. H., Swetz, K. M., Dy., S., Tien, A. Y., Temel, J. S., & Abernethy, A. P. (2012). Integrating technology into palliative care research. Current Opinion in Supportive and Palliative Care, 6(00), 1-8. doi: 10.1097/SPC.0b013e32835998c6