a discussion on palliative care danielle b. scheurer, md, mscr chief quality officer &...
TRANSCRIPT
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A Discussion on Palliative Care
Danielle B. Scheurer, MD, MSCRChief Quality Officer & Hospitalist
April 12, 2012 – MUSC BOT Retreat
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Background• 5% of seriously ill Americans account for 50% of health
care spending, primarily in the last year of life.• Majority of patients-families report end of life unmet
needs (pain, discomfort, emotional / spiritual distress, caregiver burdens).
• Discordance between previous wishes and actual care.• Only 30% of elderly patients hospitalized at the end of
life have documentation of their wishes in the medical record.http://content.healthaffairs.org/content/32/3/552.full.html
Heyland DK. JAMA Intern Med. Published online April 01, 2013. doi:10.1001/jamainternmed.2013.180
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Background
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Hospice enrollment and Medicare savings
• Time of hospice enrollment and savings per beneficiary (compared to non-hospice)
• 1-7 days before death: $2,500• 8-14 days before death: $5,000• 15-30 days before death: $6,500
http://content.healthaffairs.org/content/32/3/552.full.html
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Average Medicare Inpatient Spending in the Last 6 Months of Life
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Average Medicare Outpatient Spending in the Last 6 Months of Life
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http://www.capc.org/reportcard/home/SC/RC/South%20Carolina
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http://www.capc.org/reportcard/home/SC/RC/South%20Carolina
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Current MUSC Palliative Care Resources
• Inpatient Clinical Service– 1.5 FTE physician, 1.0 FTE APP– Available SW, case mgt, chaplain, ethics (not
dedicated to palliative care)• Interdisciplinary reviews• Screening with mandatory action (pilot)• Physician Order for Scope of Treatment (pilot)• Education Med Students, Residents, Nurses
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Future MUSC Palliative Care Resources
• Palliative care fellowship– 2 fellows annually– Proposal circulating
• Clinic / Outpatient Service– Half day weekly on site
• Research– Recruiting
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Challenges
• Culture change– Patients-Families– Physicians-Staff
• Community & State involvement– CAPC rates SC a “C” overall– Larger and non-for profit hospitals more likely
to offer services– Non-hospital services patchy
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Discussion Points
• Spending is very high at the end of life.• Many patients-families do not receive care
concordant with wishes at end of life.• Early palliative care involvement is best.• MUSC should be a mentor in the state on
the creation and sustainment of in-outpatient palliative care services.