In the second segment of the discussion between Bruce A. Feinberg, DO, vice president and chief medical officer at Cardinal Health Specialty Solutions, and Brian B. Kiss, MD, vice president, healthcare transformation, Blue Cross Blue Shield of Florida, the panelists discuss costs and coordination of palliative care, oncology care, and end-of-life care.
Dr Kiss believes that while palliative care can instill some cost savings, it should not be viewed as an opportunity to withdraw more expensive care. “You have to provide the care that’s necessary to assure the best function and pain relief for that patient at that time,” he says. Some cost savings may be realized if a patient’s end-of-life symptoms are treated at home or in hospice instead of a hospital, and by avoiding the use of ineffective active treatment toward the end of life.
Resources that are consumed in the last 30 days of life, especially in end-stage cancer patients, according to Dr Feinberg, are huge, predictable, and avoidable. Most of the costs are related to emergency department visits, intensive care unit stays, hospitalizations, and physician consultations that can be avoided if we move toward a patient-focused culture and more readily consider palliative care.
Dr Feinberg says palliative care has focused “on that transition from active curative treatment to support care in order to maximize quality of life.” It was not part of his medical training and had to be “learned on the street.” Improved training in fellowship programs would be a real help, he suggests.
Dr Kiss points out that as a nephrologist, he regularly deals with end-of-life care resulting from renal failure. He doesn’t usually hand off the patient to another specialist for palliative care issues. He wants to be responsible for that patient’s entire care, like oncologists, and understands their reluctance to address only curative or aggressive treatments.
Discussions about having a palliative care physician join the oncology team are ongoing, says Dr Feinberg, but he struggles with the idea that another caregiver is needed. Dr Kiss responds that it may be less a question of specifically ending oncology care efforts and beginning palliative care efforts, than of bringing on that palliative care physician to co-manage the patient at certain stages of disease—emphasizing team-based management.