With palliative care, house calls stage a comeback

House calls prevent expensive readmissions

Some hospitals are offering house calls to patients in their palliative care programs in an effort to prevent readmissions, provide better care, and reduce costs, Milt Freudenheim reports in the New York Times.

How house calls can cut hospitalizations

A 2007 study found palliative care patients were less likely to visit the ED or be hospitalized when they received in-home, team-based care than patients who received more-traditional home care.  A vast majority of these patients—not quite ill enough for hospice care—would rather be at home than in a hospital anyway, says R. Sean Morrison, co-director of the Patty and Jay Baker National Palliative Care Center at Mount Sinai Hospital in New York. Moreover, home care is less expensive than hospital care and more affordable thanks to Medicare and Medicaid incentives.

In cases where insurance does not cover palliative care, some hospitals are financing it themselves—often with grants, Freudenheim writes.

How hospitals are approaching the home care business

At the Baker Palliative Care Center, palliative teams work with the patient's regular physicians and specialists to "provide an added layer of support for people living with serious illness," says co-director Diane Meier. Instead of intensively focusing on one disease, these teams can focus on the whole patient—pain management, depression, fatigue, and supporting "exhausted and overwhelmed family caregivers," Meier added.

Meanwhile, Massachusetts General Hospital and Brigham and Women's Hospital provide palliative care patients the option to continue treatment at home. Under the program, patients will receive house calls from nurses, palliative care doctors, and social workers, as well as follow-up phone calls. "The home care nurse is the eyes and ears and stethoscope in the patient's house," says Timothy Ferris, who runs the Partners HealthCare ACO.

Proponents of palliative care say it helps patients with terminal illnesses plan realistically for their future. However, studies have also found that it "may be associated with a significant prolongation of life for some patient populations," Meier noted in a 2011 article.

Walter Park, who suffered a heart attack in 2012, says house calls prevented him from making an expensive return visit to the University of California-San Francisco (UCSF) Medical Center after spending seven weeks recuperating there. After being discharged, palliative care specialists from UCSF monitored his recovery—physically and emotionally—through house calls. The specialists also helped him sort out the 20 pills he took daily and complete household chores.

"I used to plan only three years ahead," Park says, adding now he wants to see his 8- and 11-year-old "grandkids grow up and graduate" (Freudenheim, New York Times, 4/19).

Expanding palliative care across the continuum

As you begin to think about further expanding your palliative care program, determine the strategic goals for outpatient expansion, and use those goals to guide model selection and performance measurement.

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