Palliative Care Programs

January 12, 2021 | Health System Risk Management

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The provision of palliative care involves quality, legal, regulatory compliance, patient safety, and ethics issues that are generally familiar to risk managers and corporate compliance officers. However, the rapidly changing regulatory and reimbursement environment in which palliative care is delivered requires more focused attention to these issues.

Healthcare providers, patients, and their families must have a clear understanding of the distinction between palliative care and hospice care. Failure to distinguish one from the other may result in regulatory compliance failures, preventable ethics dilemmas, and harm to patients.

In the United States, the concept of palliative care grew out of the hospice movement for end-of-life care. But unlike Medicare-certified hospice care, palliative care is not reserved solely for patients certified by a hospice medical director to have a six-month life expectancy and who are expected to forgo curative treatment (CMS "Medicare").

Palliative care is increasingly recognized as an integral component of comprehensive intensive care for seriously ill adult and pediatric patients and patients with significant chronic conditions, such as neurologic, cardiac, and pulmonary disease (Puntillo; CAPC "America's Care"). NCP has identified adult and pediatric patient populations with serious and life-threatening illness within a broad range of diagnostic categories for whom the provision of palliative care is appropriate as an adjunct to standard medical care (NCP; Hauser et al.). For more information, see Populations to Be Considered for Palliative Care.

Studies have shown that patients receiving palliative care experience improvement in the quality of their lives. Palliative care reduces hospital costs by ameliorating pain and other distressing symptoms that increase hospital lengths of stay; reduces the provision of unnecessary, ineffective, or marginally effective interventions that may also result in complications requiring additional intervention; and provides safer patient-centered transition-of-care plans (Elsayem et al.; Morrison "Cost Savings"; Morrison "Palliative"). Hospital palliative care programs also improve caregiver...

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