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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3 thoughts on “Week 13: 4/11-4/17-Sustaining and Funding Innovation”

  1. Thank you for your post on sustaining and financing innovation in palliative care education. It is exciting to me that this bill will push for palliative care education in schools. This seems like such a valuable and necessary step toward enhancing palliative care services. Palliative care is often intimidating, especially for new practitioners. Horowitz, Grumling, and Quill (2014) recommend that basic competencies of palliative care should be integrated into all years of medical school. This may relieve some of the fear, however, it seems that palliative care service might be a beneficial rotation in residency programs as well. In the hospital that I currently work in, this is not a mandatory rotation for residents, although all who have elected to complete the rotation said it was extremely worth while. Hopefully, this bill will lead to enhanced education at the foundational level.

    Horowitz, R., Grumling, R., & Quill, T. (2014). Palliative care education in U.S. medical schools. Medical Education, 48(1) 59-66. doi: 10.1111/medu.12292

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  2. Sarah, I suspected that palliative care would help save costs in the long run, but almost a $7,000 savings in any given hospital admission is astonishing (Morrison, Dietrich, Ladwig, Quill, Sacco, Tangeman, & Meier, 2011). I completely agree that if policy makers can focus on the long-term savings rather than the initial investment cost, they would take action more quickly. Unfortunately, seeing the vision seems to be easier said than done in many cases.

    You mention that as palliative education becomes more routine in healthcare professional’s education, it will eventually become a part of common practice. I agree and am making the same argument about interprofessional collaboration (IPC) for my DNP project. Neither IPC or the utilization of palliative medicine have significant added cost to initiate, yet for much of the older generation of providers it has not been a part of their routine practice and thus does not get the attention it deserves. While new research is always needed, I think better utilization of the palliative care services that already exist would be an excellent start. Great work on this topic throughout the semester!

    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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  3. I imagine that some of the funds directed to research by HR 3119 will need to include continued evaluation of the financial benefits of innovative palliative care programs. This can be the first step towards additional and sustained funding. For example, I’m familiar with a palliative care program in Phoenix, AZ (specific to helping people with dementia and their families) that saved enough money during the initial phase that it now receives reimbursement from a few insurance companies.

    As you mentioned, palliative care is directed by the goals of the patient. Do you think this will be increasingly important with the shift to value-based reimbursement? Are people receiving palliative care also more satisfied?

    It will be fascinating to see what the Congressional Budget Office determines through the financial analysis process, and if all of the statistics on cost savings that you mention will be prominently considered. I hope so! There is a looming crisis with the aging population and upcoming healthcare needs, and palliative care is a stand out solution.

    I’ve enjoyed reading your blog- thank you for all of your informative posts!

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