Hospice and palliative care have been my primary specialties as a medical journalist for the past 25 years, but I also write for The Hospitalist magazine, which is published for physician members of the Society of Hospital Medicine. Hospitalists, physicians whose jobs are basically spent inside the hospital, have been a rapidly growing part of the U.S. health care system since the term was coined in 1996. Preventing unnecessary readmissions for patients discharged from the hospital has become a huge and growing obsession for this field -- especially under health care reform. The government recently announced a $500 million grant program to support innovative community coalitions working together with hospitals to help prevent the communication breakdowns and other dropped balls that frequently cause discharge plans for seriously ill patients coming home from the hospital to go awry -- which too often necessitates a return to the emergency room or to a hospital bed. And in the not too distant future, Medicare will penalize hospitals that have higher-than-average rates of readmissions.
Hospices and palliative care programs believe they offer beneficial services shown to prevent unnecessary hospitalizations for seriously ill patients, in part by encouraging patients and families to reflect on their values and goals for treatment at this time of life, and then by providing effective coordination of care that makes it easier for patients to remain at home -- rather than returning to the most-unhomelike atmosphere of the hospital. But these advocates aren't necessarily communicating with the hospital administrators and health policy leaders who are now zeroing in on the phenomenon of the preventable hospital readmission, rates of readmissions, and their costs -- economic and personal -- to the patient, to the hospital and to the health care system. These conversations about readmissions and about palliative care seem to operate in parallel universes that just aren't talking to each other. In a time of rapid change in the health care system, there needs to be a way to connect the dots, and to have hospice and palliative care advocates step forward as major parts of the solution to the problem of readmissions.
Earlier this week the health care technology company Care Team Connect offered an audio seminar on "The Role of Palliative Care In Reducing Preventable Readmissions", presented by Dr. John Loughnane, director of hospice and palliative medicine at Commonwealth Care Alliance in Boston. Much of this presentation was about the basics of palliative care, how to make the case for it in a hospital -- the same program that The Center to Advance Palliative Care has been promoting for the past decade.
But Dr. Loughnane showed how a family conference with seriously ill, repeatedly hospitalized patients and their families can point to a care plan that is more likely to succeed once the patient leaves the hospital. He also extolled the practical benefits of hospice care for those patients sick enough and emotionally ready to qualify for hospice -- particularly the 24-hour availability of a hospice nurse able to respond to crises in the care of patients in their own homes. He was asked who should palliative care advocates talk to in the hospital and he identified several likely targets. These include intensivist physicians in the ICU, the manager of the hospital's hospitalist program, the most respected nurses on the floor, the care managers responsible for coordinating discharge planning, and the hospital administrator most likely to be open to this conversation.
I am still very interested in how to connect the dots between these two huge trends in the American health care system, but it was encouraging to see others starting to talk about how to do this.