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A Discussion on Palliative Care

A Discussion on Palliative Care. Danielle B. Scheurer , MD, MSCR Chief Quality Officer & Hospitalist April 12, 2012 – MUSC BOT Retreat. Background. 5% of seriously ill Americans account for 50% of health care spending, primarily in the last year of life.

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A Discussion on Palliative Care

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  1. A Discussion on Palliative Care Danielle B. Scheurer, MD, MSCR Chief Quality Officer & Hospitalist April 12, 2012 – MUSC BOT Retreat

  2. 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

  3. Background

  4. 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

  5. Average Medicare Inpatient Spending in the Last 6 Months of Life

  6. Average Medicare Outpatient Spending in the Last 6 Months of Life

  7. http://www.capc.org/reportcard/home/SC/RC/South%20Carolina

  8. http://www.capc.org/reportcard/home/SC/RC/South%20Carolina

  9. 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

  10. Future MUSC Palliative Care Resources • Palliative care fellowship • 2 fellows annually • Proposal circulating • Clinic / Outpatient Service • Half day weekly on site • Research • Recruiting

  11. 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

  12. 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.

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