Realizing the Full Benefit of Palliative Care

Service Optimization and Strategic Growth

Topics: Palliative Care, Methodologies, Performance Improvement, Care Transformation, Length of Stay, Efficiency, Readmissions, Quality, Mortality, Physician Issues, Margin Performance, Finance

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By reading this study, members will learn how to:

  • Develop a palliative care service that meets the needs of clinicians and patients
  • Grow palliative care services and demonstrate the impact on costs and quality
  • Engage physicians to overcome resistance, gain buy-in, and increase referrals
  • Overcome capacity challenges by employing a generalist palliative care model

Executive Summary

Effective palliative care can transform inpatient care delivery by reducing costs while improving quality for the sickest patients—in both fee-for-service and risk contracting environments. 

This study contains best practices for increasing the value of your palliative care service by engaging physicians, growing referrals, and expanding palliative care skills across the medical staff.


Reach more patients to grow value

It’s important to understand that palliative care is not hospice—it’s defined as specialized medical care for patients with serious illness designed to improve quality of life. Palliative care emphasizes pain and symptom management, counseling for patients and families, support for patients making decisions about their treatment and goals of care, and care coordination.

While experts say that 5-10% of inpatient admissions should receive a palliative care specialist consult, most hospitals are falling far short of this mark. To maximize the cost and quality benefits of palliative care, institutions must strive to reach all patients who would benefit from these services.


Physician relationships key to consult service growth

Whether highly developed or just starting out, palliative care programs depend on engaged and informed physicians. This sometimes means a fundamental shift in physicians’ understanding of this aspect of patient care. Growing the program will require cultivating a dialogue with clinicians, establishing services that meet the needs of physicians and their patients, and building upon this foundation of mutual trust as the program grows.

This study offers lessons to establish the inpatient palliative care service by engaging physicians at each phase of the process, from conducting a needs assessment to phased expansion of services. It also provides guidance on appropriate palliative care team staffing and measuring performance to demonstrate impact.

“You have to evaluate the culture of your institution. We hired a palliative care physician specialist to begin with because we knew our organization would be less receptive of a nurse leader. When we gradually brought in palliative care nurses, the old guard began to change.”

-Director of Palliative Care, Health Care System in the Northeast


Engage "generalists" to meet broader patient needs

While a robust inpatient consult service can meet the palliative care needs of the most complex cases, these services have their limits: mainly, a shortage of palliative care specialists.

A top-of-license palliative care model meets all patient needs by appropriately using providers trained to address them at each level. Palliative care specialists provide advanced management of complex symptoms and emotional issues, while the broader medical staff, referred to as “palliative care generalists,” address patients’ basic needs, including management of pain and other symptoms, discussions about prognosis and the goals of treatment, and more.


Resources for moving to the next level

To help providers implement these strategies, we've compiled the Palliative Care Program Development Toolkit.

The toolkit contains additional resources and strategies to prepare for cross-continuum palliative care success. It also contains tools to expedite palliative care program development, including:

  • A palliative care cost savings estimator
  • Sample metric dashboards for each phase of growth
  • A ready-to-use PowerPoint template for making the case for program growth
  • On-demand webconferences highlighting key topics and resources

The Palliative Care Imperative