Devine Grades Healthcare Sector with a “B”

Expansion Must be Balanced with Reimbursement

The Chamber of Commerce Southern New Jersey stages a very successful, well-attended quarterly South Jersey Business Outlook where panelists from different industries grade the economy today and also provide their six-month forecasts.

Representing the consumer healthcare industry on the panel in June was Joseph W. Devine, FACHE, who is President and Chief Experience Officer of Jefferson Health New Jersey and Chairman of the Boards of the New Jersey Hospital Association and the Chamber of Commerce Southern New Jersey, where I’m a fellow Board member.

In spite of never before seen revenue growth and expansion, Devine gave the healthcare industry a B grade for both now and his six-month forecast.  That’s because of “uncertainty,” Devine said.  “We have to balance investment and (government) reimbursement.”  Government reimbursement rates are forever changing and unpredictable.  Still, healthcare expansion in New Jersey is robust and gaining strength.

Five hundred million dollars in taxes contributed to the State of New Jersey.  More than $565 million in free care to state citizens.  More than 120,000 full time hospital employees.  These are some of the statewide economic impact statistics Devine provided.

Investment in South Jersey Healthcare is Staggering

Closer to home and specific to Southern New Jersey, Devine said Inspira Health Network is spending $356 million building its new hospital near Rowan University in Mullica Hill, Gloucester County and that Jefferson Health is spending more than $450 million on expanding its campuses in Cherry Hill and Washington Township, Camden County.

Devine called the amount of new investment “staggering.”  And all the major players are also buying new electronic health record (EHR) platforms, if they don’t already have them, including Jefferson Health New Jersey, which spent $115 million on a “Cadillac” EHR, which goes live in September.  “This is what consumers expect,” Devine said.  “You have to have it (an EHR.)”

Globally, venture capitalists have invested more than $9 billion in digital healthcare and Alphabet, Google’s parent company, has acquired more than 60 healthcare companies in recent years, Devine continued.  And speaking of healthcare tech, Jefferson is driving innovation by partnering with five different startup companies in Silicon Valley.

So, what does this all mean for a local, independent healthcare communications consultancy?  After years of supporting both for and nonprofit healthcare companies, two years ago, the expanding, diversifying healthcare sector Devine described is why my agency Simon PR reinvented itself as SPRYTE Communications, a specialist in the healthcare provider space.

While Devine’s optimism was guarded due to government’s unpredictable reimbursement posture, my excitement grew as his remarks continued.  There are so many outstanding healthcare prospects for SPRYTE to pursue in New Jersey.  I’m not ready to give SPRYTE a grade but in a cautiously optimistic way, I believe, we are very well positioned for the healthcare marketplace today and in the future.  -Lisa Simon

Juneteenth – America’s Other Independence Day

Patient Experience Relies on Understanding Diverse Perspectives

Americans love their Fourth of July holiday. After all, it’s America’s birthday – the day we traditionally set aside to celebrate the signing of the Declaration of Independence and the establishment of a free nation where “all men are created equal.”

But for many, those hallowed words proved hollow. Hundreds of thousands of slaves throughout the young United States – especially in the South – would need to wait almost another century before their rights to equality were officially recognized.

Another View of History

On July 5, 1852, famed African American abolitionist Frederick Douglass, himself a former slave, delivered an impassioned speech spelling out the irony inherent in the July 4th celebration:

“This Fourth of July is yours, not mine. You may rejoice, I must mourn,” Douglass said. “What, to the American slave, is your Fourth of July? I answer: a day that reveals to him, more than all other days in the year, the gross injustice and cruelty to which he is the constant victim…”

It would take another 13 years, hundreds of thousands of lives, and a Civil War that tore apart the fabric of the American nation before four million African-American slaves would get their own taste of freedom.

Juneteenth – Freedom Reborn

On June 19, 1865, Union General Gordon Granger, military commander of the defeated Confederate state of Texas, read aloud General Order No. 3, telling the populace of Galveston that: “The people of Texas are informed that, in accordance with a proclamation of the United States, all slaves are free.”

Spontaneous celebrations among the newly freed African American population quickly erupted across the South as Juneteenth was born. African-American communities across the U.S. soon adopted Juneteenth as their own holiday, using it as an occasion for celebrating freedom with public events, picnics and church gatherings.

Understanding Leads to Compassion

Once we understand the history of Juneteenth and how it came into being, it’s easier to appreciate why many African Americans consider Juneteenth to be a day to celebrate not only the vision of freedom President Lincoln described in his 1863 Emancipation Proclamation but also the original promise of the Declaration of Independence.

Since our childhood, we’ve been told that America is a melting pot, comprised of people from all over the world, representing a multitude of religious backgrounds, races, cultures, customs, languages and lifestyles.

Healthcare providers face the everyday challenge of understanding how these differentiating factors may affect individuals’ or families’ attitudes toward illness, pain, coping and death. It is important to appreciate why these attitudes are held, because they can significantly influence their willingness to explore various treatment options. Hospice, in particular, can be an especially touchy discussion topic.

For example, according to statistics, African-Americans comprise approximately 12% of the U.S. population, but they make up only 7.6% of hospice patients. Ironically, African-Americans have a disproportionately higher rate of cancer and heart disease, which are among the top hospice diagnoses.

Researchers point out several reasons for this incongruity. As a rule, African-American families tend to be less trustful of the American healthcare system. In addition, because medical decisions tend to be made within the family, there may be a reluctance to consult with a new, unknown healthcare professional or someone outside the home. Finally, statistically speaking, African Americans tend to be especially reluctant to cease life-prolonging procedures such as tube feeding, organ donation, and palliative care in the hospice setting – because extending life is generally seen as something to be preferred.

Honoring Differences

Healthcare communicators need to recognize that their messages may be perceived very differently by diverse audiences and adjust accordingly to ensure positive patient experience.

As the U.S. healthcare system continues to evolve to one that is more population health-oriented and patient-centered, there is a growing need for healthcare providers to educate patients, families and the general public about what they can do to stay healthier, as well as the nature of specific healthcare challenges and treatment options.

Understanding their emotions, how they think, and the reasons behind these different perspectives is vital to helping patients and families make treatment decisions that are most appropriate for their individual situations.

It’s not unlike coming to appreciate the Juneteenth holiday. The better we understand the history and background of our patients, the better we can understand and honor the views and emotions that influence their decisions and actions.

-Thomas Derr

Palliative Care’s Patient Focus

Putting the “Care” Back in Healthcare

We live in a remarkable era of scientific and medical advancement.

The healthcare industry has developed a vast array of techniques and tools that can be used to treat patients. Surgery. Medications. High-tech things such as gene therapies.

There is so much more we can “do” to patients than ever before!

But is it always the right thing to do?

According to Dr. Timothy Ihrig, an internationally recognized authority on palliative care and Chief Medical Officer at Crossroads Hospice & Palliative Care (Full disclosure: A SPRYTE Communications client), the answer is a resounding “NO!”

The Tao of Palliative Care

In his blog, What’s Wrong with Healthcare? It doesn’t Care (Part II), Dr. Ihrig suggests that as doctors have become more adept at fixing the physical ailments that patients suffer, they’ve grown less mindful of them as human beings, perhaps to the point of callousness in regard to how patients feel about the treatments being thrust on them. He believes the healthcare industry needs to do a much better job of educating patients about procedures, treatments, and the likely prognoses, so they can be part of the decision-making process.

“My experience is, the more we ‘do’ to patients, the more we risk negatively impacting the quality of their lives – and the more we risk actually decreasing how long they live, as well.  In addition, too often – almost always – we are not giving the patient an opportunity to choose HOW they want to live.” Dr. Ihrig says.

He believes palliative care practitioners are well-positioned to show the healthcare industry how best to engage with patients so they can participate in treatment decisions and establish goals that allow them to enjoy a high quality of life for as long as possible. Read!

Published September 11, 2018 by Spryte Communications in Public Affairs

Curing What Ails Healthcare

Hospice and Palliative Care Blaze a Path for Needed Changes:

We’ve all heard the old healthcare adage: “The cure is worse than the disease.”

Medical education trains physicians to fight disease. Generally, that means treating the symptom that the patient is experiencing. And then the next one. And then the one after that.

How much say does the patient have in the treatment plan? Too often, very little, if anything at all.

That’s a real problem, according to Dr. Timothy Ihrig, an internationally recognized authority on palliative care who joined Crossroads Hospice & Palliative Care (a SPRYTE Communications client) as Chief Medical Officer earlier this year.

Dr. Ihrig believes patients deserve to be fully informed of their condition, what it entails, the likely prognosis, and the likely trajectory of the disease. And that  patients should be involved in important decisions that can affect their quality of life.

“True palliative care” offers an important, proactive, inclusive way of addressing individual patient needs and wishes, while at the same time serving as a key driver in the effort to reduce healthcare costs.

In his blog, What’s Wrong with Healthcare? It Doesn’t Care (Part I), Dr. Ihrig begins to map out how that perspective underscores his desire to “start a movement of thought and inspire others to seek not healthcare reform but a reforming of how we care for others within the healthcare system.”

Find out more about SPRYTE’s Public Affairs services.

Published August 14, 2018 by Spryte Communications in Public Affairs

Patriotic Symbolism Helps Promote a Timely Cause

What do July 4th and the Opioid Crisis Have in Common?

Tie-ins to patriotic holidays are a time-tested avenue for promoting a product or business.

How many times have we seen Presidents’ Day promotions for Lincoln lounge suites or Washington white sales? (Far too often, I think you’ll agree.)

Getting Serious

But from a public affairs standpoint, despite the all-too-common campy come-ons, there is still value in the patriotic connection strategy – if it is done in a way that respects and pays homage to the historical precedent.

Anyone who has read a newspaper or watched the TV news is aware that opioid abuse has reached epic proportions across the United States. Our client, Relievus, a physician practice specializing in pain management, wanted to enhance its brand reputation in a way that reflected a commitment to the communities it serves.

SPRYTE recommended a letter to the editor campaign encompassing community newspapers throughout Relievus’ service region – including 15 locations across South Jersey, as well as Philadelphia’s Mainline, Northeast Philadelphia and the surrounding suburbs. To emphasize the local connection and maximize impact, the doctors’ offices in each respective community were correlated to individual local papers.

The theme was Independence Day and was timed to land right as the Fourth of July holiday took place. The analogy of patients struggling to overcome opioid addiction as a modern day fight against oppression and the need to band together for a common good proved to be a popular message, as the letter to the editor was picked up by newspapers throughout Relievus’ New Jersey and Pennsylvania footprint:

Toward a New Independence Day

Dear Editor,

On July 4th, millions of Americans will come together to celebrate the signing of the Declaration of Independence, an historic testimonial against oppression that still inspires people around the world.

Today, millions of Americans are confronting another kind of oppression – opioid addiction. At Relievus, we see the effects of this horrible epidemic every day. It has destroyed families, ruined lives and even led to an historic decrease in lifespan among sectors of the U.S. population.

According to recent reports,  in 2016, 11.5 million people misused prescription opioids, while over 42,000 died from an opioid overdose. Roughly 40% of those deaths involved a prescription opioid. But the impact isn’t limited to opioid abusers. Another report puts the economic impact of each opioid overdose death at approximately $800,000.

It’s important to understand that people who abuse opioids are not weak or inferior. They simply are people trying to deal with their pain. Eventually this pain becomes difficult to manage until it begins affecting their quality of life.

Weaning patients off opioids is an important step. But managing pain takes an intense, multi-faceted approach. Most need social support, behavioral therapy and/or individual counseling. They cannot do it alone. It will take a united and coordinated front.

On this Fourth of July, let us reignite the spirit of American courage and community. Let us work to create a new dawn of independence from the oppression caused by the abuse of opioids and other drugs.

Young J. Lee, MD
Relievus

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Moral of the Story

Even in our current, often-divisive times, a message of community and concern for the greater good can still resonate widely. Perhaps today, more than ever, it’s important to look back to those positive themes that helped establish and develop our nation and use them as a guide as we create our future. As hallowed forefather Benjamin Franklin observed just before signing the Declaration of Independence: “We must, indeed, all hang together, or most assuredly we shall all hang separately.”

Find out more about SPRYTE’s Public Affairs and Media Relations services.

The Costs of Public Healthcare Benefits

Understanding How Healthcare Impacts State Budgets

There is an oft-quoted saying, usually attributed to Otto von Bismarck, the 19th century Prussian leader who became the first Chancellor of the united German Empire, that compares the production of sausage to the process of creating legislation: “It’s better not to see them being made.”

The process can be messy and unappetizing. The end product can amount to an amalgam of disparate contributors and ingredients. And while it might be satisfying when first ingested, there might be some unforeseen side-effects that crop up after the initial passage.

Because many states, including New Jersey, are in the midst of annual State Budget negotiations (with an official deadline of June 30th for passage), interested viewers will have a ringside seat as they get to watch the legislative budget deliberations at their most intense. (Note: Governor Wolf signed Pennsylvania’s FY2019 budget on Friday, June 22, the first on-time budget of his tenure.)

Healthcare Communicators Under Pressure

For healthcare communicators, particularly those who work for public organizations or entities that receive some kind of public healthcare funding, it’s important to appreciate the pressures and influences that often come together during peak budget deliberations.

At a recent meeting of the Health Issues Committee of the Chamber of Commerce of Southern New Jersey, Tom Byrne, Managing Director and Head of Equity Portfolio Management for Byrne Asset Management, provided an overview of the role public healthcare benefits increasingly play in state budget deliberations.

For New Jersey in particular, public healthcare benefits and pensions “are a huge albatross,” said Byrne. That includes the costs of providing healthcare coverage and pension contributions to the many thousands of public employees, including elected officials and their staffs, judges, police, fire and rescue personnel, teachers, superintendents and other personnel throughout New Jersey’s approximately 678 operating public school districts, and more.

Many of these public employees are protected by unions and guaranteed contracts, so there is little incentive for them to agree to shed benefits in the budget deal-making process.

Underfunded Pensions in NJ

One of the key challenges New Jersey budget negotiators face is the past. Over the course of years, budget-negotiators sought to balance the books by underfunding public pension allocations, hoping to make it up at some point in the future when the state’s economic situation became rosier.

Unfortunately, spending on other concerns always seemed to take precedent. As a result, New Jersey faces one of the most dire pension shortfalls in the country. How serious is it? Other states have come out of similar pension problems, but never one this deep, Byrne said.

public healthcare benefits
Tom Byrne, Byrne Asset Management

In March, New Jersey Governor Philip Murphy proposed an allocation of $3.2 billion toward pensions in FY 2019, a 28% increase over last year’s contribution. The proposal noted that this contribution would be larger than the total of all contributions made during the previous administration’s first four years. Even so, it’s only a start to making it whole.

More Funding for Education, Healthcare

In addition, Gov. Murphy proposes increasing state funding for public education, including an expansion of Pre-K and STEM education, Pursuing Tuition-Free Community College, and expanding student aid.

In addition, he has proposed increases in funding for healthcare coverage for low-income citizens, family planning, mental health and addiction services, developmental disabilities services, the Supplemental Nutrition Assistance Program (SNAP) and hospital funding – all worthwhile-sounding investments.

But to arrive at a balanced budget, what’s given out in one area has to be taken back in another – unless the pie is enlarged. That means raising taxes. With New Jersey property owners already paying some of the highest property taxes in the nation, the practicality of continually going back to that well is questionable. An increase in the sales tax is one proposal. Also a “millionaire’s tax” and a proposed fee on carried interest that would focus on Wall Street earnings.

Pushback Expected

Byrne said he expects there to be some discussion about revising public healthcare benefits – incorporating more wellness and in-network programs and requirements as a means to lower overall spending. But such suggestions are only part of the answer, Byrne said.

The fact is, pension and healthcare costs are crowding out a larger and larger share of discretionary spending. And powerful interests with a desire to maintain an existing state program or allotment will be pressuring lawmakers to protect those concerns.

“If you cut eight million dollars from the state budget as a line item, you won’t get eight million thank-you notes from people for saving them a dollar each,” explained Byrne. “But you may upset powerful interests.” That’s something most elected officials try to avoid.

Adding to the uncertainty is the fact that many legislators simply don’t have expertise in public finance, pensions and public healthcare. Byrne said they need to become better educated in order to effect solutions on such complex issues. And soon.

Healthcare will likely be a major component of any solution, but public healthcare reform is not a panacea. There are too many other interconnected variables and links that need to be sorted out before this state budget sausage is fully cooked.

Each year, as annual budget negotiations begin to percolate, healthcare communicators should make the effort to understand how the interests of their organizations line up with pending budget proposals as well as the viewpoints of their allies in the legislature and other influential government officials. Budget negotiations are often referred to as a numbers game. But the number of friendly votes you can count on are often as important as the budgetary numbers themselves.

Juneteenth – America’s Other Independence Day

Patient Experience Relies on Understanding Diverse Perspectives

Americans love their Fourth of July holiday. After all, it’s America’s birthday – the day we traditionally set aside to celebrate the signing of the Declaration of Independence and the establishment of a free nation where “all men are created equal.”

But for many, those hallowed words proved hollow. Hundreds of thousands of slaves throughout the young United States – especially in the South – would need to wait almost another century before their rights to equality were officially recognized.

Another View of History

On July 5, 1852, famed African American abolitionist Frederick Douglass, himself a former slave, delivered an impassioned speech spelling out the irony inherent in the July 4th celebration:

“This Fourth of July is yours, not mine. You may rejoice, I must mourn,” Douglass said. “What, to the American slave, is your Fourth of July? I answer: a day that reveals to him, more than all other days in the year, the gross injustice and cruelty to which he is the constant victim…”

It would take another 13 years, hundreds of thousands of lives, and a Civil War that tore apart the fabric of the American nation before four million African-American slaves would get their own taste of freedom.

Juneteenth – Freedom Reborn

On June 19, 1865, Union General Gordon Granger, military commander of the defeated Confederate state of Texas, read aloud General Order No. 3, telling the populace of Galveston that: “The people of Texas are informed that, in accordance with a proclamation of the United States, all slaves are free.”

Spontaneous celebrations among the newly freed African American population quickly erupted across the South as Juneteenth was born. African-American communities across the U.S. soon adopted Juneteenth as their own holiday, using it as an occasion for celebrating freedom with public events, picnics and church gatherings.

Understanding Leads to Compassion

Once we understand the history of Juneteenth and how it came into being, it’s easier to appreciate why many African Americans consider Juneteenth to be a day to celebrate not only the vision of freedom President Lincoln described in his 1863 Emancipation Proclamation but also the original promise of the Declaration of Independence.

Since our childhood, we’ve been told that America is a melting pot, comprised of people from all over the world, representing a multitude of religious backgrounds, races, cultures, customs, languages and lifestyles.

Healthcare providers face the everyday challenge of understanding how these differentiating factors may affect individuals’ or families’ attitudes toward illness, pain, coping and death. It is important to appreciate why these attitudes are held, because they can significantly influence their willingness to explore various treatment options. Hospice, in particular, can be an especially touchy discussion topic.

For example, according to statistics, African-Americans comprise approximately 12% of the U.S. population, but they make up only 7.6% of hospice patients. Ironically, African-Americans have a disproportionately higher rate of cancer and heart disease, which are among the top hospice diagnoses.

Researchers point out several reasons for this incongruity. As a rule, African-American families tend to be less trustful of the American healthcare system. In addition, because medical decisions tend to be made within the family, there may be a reluctance to consult with a new, unknown healthcare professional or someone outside the home. Finally, statistically speaking, African Americans tend to be especially reluctant to cease life-prolonging procedures such as tube feeding, organ donation, and palliative care in the hospice setting – because extending life is generally seen as something to be preferred.

Honoring Differences

Healthcare communicators need to recognize that their messages may be perceived very differently by diverse audiences and adjust accordingly to ensure positive patient experience.

As the U.S. healthcare system continues to evolve to one that is more population health-oriented and patient-centered, there is a growing need for healthcare providers to educate patients, families and the general public about what they can do to stay healthier, as well as the nature of specific healthcare challenges and treatment options.

Understanding their emotions, how they think, and the reasons behind these different perspectives is vital to helping patients and families make treatment decisions that are most appropriate for their individual situations.

It’s not unlike coming to appreciate the Juneteenth holiday. The better we understand the history and background of our patients, the better we can understand and honor the views and emotions that influence their decisions and actions.

Healthcare’s Future Lies in Transformation

Dr. Ezekiel Emanuel Offers a Compelling Argument

What will the future of healthcare look like? It’s an issue that public affairs commentators and policymakers across the political spectrum continue to debate.

In 1994, the late Dr. William Kissick, a professor emeritus at Wharton and the University of Pennsylvania Schools of Medicine and Nursing, identified three competing issues that the healthcare industry has struggled to address effectively. These issues – access, quality and cost containment – what Dr. Kissick called the “Iron Triangle of Healthcare,” continue to perplex policymakers and healthcare decision-makers to this day.

Recently one of the nation’s leading healthcare policy experts, Ezekiel J. Emanuel, MD, PhD, Vice Provost for Global Initiatives and Chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania, offered some important insights into where the national healthcare system is heading, and what it might mean for the Philadelphia region. In part he rejected the conventional notion that it is possible for health care systems to only achieve two of the three parts of the Iron Triangle.  He argued all three had to be achieved together. It was all part of a symposium on “Shaping Health Care” sponsored by the Chamber of Commerce for Greater Philadelphia and The Wistar Institute.

Lowering Costs

Finding a way to provide high-value care for all Americans – namely care marked by high quality and low costs with universal coverage – is a goal shared by providers and policymakers alike. According to Dr. Emanuel, “the only way to lower healthcare costs is to change the delivery system to ensure high quality care.”

Traditionally, one of the most significant contributors to the high cost of healthcare has been the combination of providing unnecessary services and inefficiency in how necessary healthcare services are delivered.   One example is standardization of practices so everyone – from physician to nurse to medical assistant – handles the same complaint according to agreed-upon guidelines. For instance, physicians in one local oncology practice were treating mouth sores after chemotherapy in different ways.  The practice standardized to one optimal practice that everyone followed.

Another common example is the fact that some health care groups allow their physicians to control their schedules, leading to double-booking, limited hours, and an inability to work around no-shows or walk-ins.

Creating Efficiencies

Dr. Emanuel identified 12 transformational practices that he says can help physician practices and healthcare organizations improve the quality and cost of care they provide to their patients:

  1. Scheduling
  2. Registration & rooming
  3. Shared decision-making
  4. Performance measurement
  5. Standardization
  6. Chronic Care management
  7. Site of service
  8. De-institutionalization
  9. Behavioral health management
  10. Hospice
  11. Community interventions
  12. Lifestyle interventions

Many of these practices will improve  efficiencies – lowering per unit costs by finding ways to improve a healthcare process or system, or working in collaboration with partners in a way that benefits all involved parties. Others will eliminate unnecessary and undesired services – lowering total costs.

Even seemingly minor changes can show major results. For example, streamlining scheduling practices can offer several benefits: 1) It allows practices to accommodate walk-ins without long wait times instead of sending them to the more expensive emergency room; 2) it increases provider efficiency, as physicians no longer double book or adjust schedules; and 3) it decreases the amount of time wasted due to missed appointments.

Similarly, Dr. Emanuel noted that transformational organizations are providing more services, such as palliative care, in the home. This care is initiated well before a patient becomes terminally ill and is ready for hospice. This approach elicits patients’ preferences for life-sustaining treatments, such as respirators, ICU admission, or dialysis, and tries to keep them at home for the last year of life. It also makes transitioning to hospice in the last weeks of life less abrupt. All these changes lead to care that is both less costly and more in accord with patients’ wishes.

Performance Measures

The pathway for healthcare providers to truly transform also involves the use of real-time performance measures, Dr. Emanuel said. Standardizing clinical practices and treatment procedures based on measurable qualitative data is vital to reducing costs and improving outcomes.

While some physicians may insist that “their” way is the best, organizations need to convince them to adhere to guideline-driven standards. Paradoxically, one effective way to persuade doctors to adapt to standardized measures is to task them with developing the standardized practices and encourage adherence through financial incentives.

At the same time, organizations need to improve their risk adjustment skills in order to continue to improve their healthcare management practices. Risk adjustment is defined as “a statistical process that takes into account the underlying health status and health spending of the enrollees in an insurance plan when looking at their healthcare outcomes or healthcare costs.”  This ensures physicians who see sicker patients are not penalized.

The ultimate goal is to transform the U.S. healthcare structure into a truly patient-centered, efficient and cost-effective system.  Dr. Emanuel notes that the Philadelphia region is a leading example of how organizations are learning to work together to achieve those goals. He said he is confident that by 2030, the entire world will be looking at the United States to understand how healthcare transformation is accomplished.

Palliative Care Comes of Age

Once Seen as an End-of-Life Specialty, Palliative Care has Moved into the Mainstream

“It is not death that a man should fear, but he should fear never beginning to live.”

– Marcus Aurelius

For David R. Barile, MD, a geriatric medicine specialist based in Plainsboro, NJ, it was the steady calm of one of his patients – a grandmother and a woman diagnosed with a terminal illness that reinforced his vision of the promise of palliative care.

Faced with a life-threatening illness, she most likely was looking at weeks of chemo and radiation therapy that may or may not cure her. But either way, the treatments would sap her strength and make it extremely difficult to carry on with everyday activities she enjoyed.

But there was one more thing. No matter what, she did not want to do anything that would cause her to miss her grandson’s bar mitzvah. The best approach for helping her achieve her goal of living life the way she wanted? Palliatve care, which focuses on providing relief from the symptoms and stress of a serious illness.

A Question of Choice

For many doctors, the idea that a patient would choose to exert such a strong influence on her course of treatment might sound unusual. But to Dr. Barile, that kind of insight is something that has been lacking for too long.

Dr. Barile is also the founder and Chief Medical Officer for Goals of Care Coalition of New Jersey, an interdisciplinary partnership of leaders representing healthcare providers and systems, government agencies, and community organizations whose mission is to encourage patients, doctors and family members to talk about what type of care they want when facing a serious illness and to document their preferences in a care plan. Increasing awareness about benefits of palliative care is a key part of the effort. Recently, Dr. Barile discussed the topic of palliative care as a featured speaker at a Health Issues Committee Forum sponsored by the Chamber of Commerce Southern New Jersey. (Note: SPRYTE Communications’ CEO Lisa Simon is a member of the chamber’s board of directors.)

“The Coalition’s fundamental purpose is to organize medical care to help patients achieve their life goals,” explained Dr. Barile. The approach consists of four basic steps:

  • Diagnosis
  • Prognosis
  • Identifying patient goals
  • Aligning treatment to achieve those goals

Setting Goals

It sounds simple. But as Dr. Barile notes, it’s also somewhat uncommon. More common is the  approach of “diagnose then treat.” That works well in most health situations, but falls short in end-of-life care, Dr. Barile says. And for many patients it creates a very stressful and unwanted burden.

What is often lacking is patient input, he says. What are their personal goals? And what kind of treatment plan can be developed that will enable them to meet those goals?

Another advocate for increasing awareness about palliative care is Dr. Timothy Ihrig, Chief Medical Officer for Crossroads Hospice & Palliative Care (full disclosure: a SPRYTE client).

Dr. Timothy Ihrig

Dr. Ihrig is an internationally recognized expert on hospice and palliative care and a longstanding advocate for treating patients with life-limiting illnesses according to their individual priorities and life goals – incorporating full transparency and quality of life as key values in their care programs.

 

His TED Talk, “What We Can Do to Die Well,” urges doctors to focus not so heavily on clinical interventions at the expense of overlooking patients’ overall quality of life and helping them navigate serious illnesses from diagnosis to death with dignity and compassion.

According to Ihrig, at its best, palliative care is meant to be an empowering force for patients, taking into account each patient’s perception of what it means to live with a severe, chronic, potentially fatal condition and helping them live their lives with the highest quality possible.

Improving Education

Both Drs. Barile and Ihrig believe more needs to be done to incorporate end-of-life issues into medical training, so healthcare professionals can better recognize what is happening to their patients. Better training will also enable them to communicate more effectively with their patients, help them achieve informed consent in their decisions, and mutually agree on a treatment program that will meet patients’ personal goals while providing a better quality of life.

“We need to work on the language for end-of-life care,” Dr. Barile says, noting that news stories about former First Lady Barbara Bush reported that she had “stopped treatment.”

“Palliative care is a treatment. But the range of treatment options available to patients needs to be better explained,” he says.

More Cost Effective

There’s an added benefit. According to a study publishd in April by the journal JAMA Internal Medicine, patients with serious or life-threatening illnesses who have palliative care discussions with their doctors at the beginning of treatment focusing on improved quality of life, managing pain and defining goals often experience shorter hospital stays and lower costs.

The JAMA study found that overall, for patients who received palliative care, hospitals saved an average of $3,237 per patient over the course of a hospital stay compared to patients who did not. Hospitals saved an average of $4,251 per stay for cancer patients, compared to an average of $2,105 per stay for non-cancer patients.

Their conclusion: “Increasing palliative care capacity to meet national guidelines may reduce costs for hospitalized adults with serious and complex illnesses.”

Higher quality care with lower costs. Perhaps an idea worth looking into.