Palliating the looming health crisis

Capitol Weekly welcomes Opinions on California public policy or politics. Please read our guidelines for opinion pieces before submitting an Op-Ed.

OPINION – With the looming federal changes to Medi-Cal eligibility and projected loss of reimbursement, healthcare organizations in California are scrambling to prepare and looking for ways to save on healthcare costs. Palliative care may help do just that.

Often, when people hear the words “palliative care”, they think of people on their deathbed on hospice services. However, hospice and palliative care are quite different. Hospice focuses specifically on people with terminal illness and is comfort-based treatment alone. Palliative care on the other hand is provided alongside curative medicine like antibiotics, chemotherapy, dialysis, or other treatments. It should be provided for anyone with a serious chronic life-limiting illness and focuses on managing symptoms and promoting quality of life. Palliative care is not a death sentence; it is an extra layer of support for patients and families that are navigating chronic disease. It’s an acknowledgement that chronic disease is more than just a physical ailment, but also a mental, emotional, and spiritual challenge that needs multidisciplinary support. Primary palliative care is delivered by primary care or non-palliative care specialists often early on in the course of an illness, while specialty palliative care is provided by palliative care specialists for patients with more complex palliative care needs.

Palliative care finds its origins in cancer care, so many healthcare providers think palliative care is only for patients with cancer. However, this is far from the truth. Palliative care has demonstrated benefits for people with other chronic diseases such as heart failure, chronic obstructive pulmonary disease, and chronic liver disease. People who receive palliative care alongside usual medical care are in the hospital or emergency room less often than people who don’t get palliative care. They report better symptom control, quality of life, and understanding about their disease trajectory. And in terms of end-of-life care, people in palliative care have a smoother transition to hospice and use less costly resources at end-of-life. It’s a win-win for healthcare organizations trying to minimize costly hospital stays and emergency room visits as well as for patients who get the benefits of extra support throughout their illness.

Having been a nurse for six years, I’ve seen too many patients who needlessly suffered from chronic illness without palliative care support. And I’ve also seen patients supported by palliative care through their illness who go on to live lives full of meaning and resilience or transition to hospice peacefully. That support from palliative care makes a huge difference. Palliative care addresses the crises before they happen so that when crises do happen, patients and families are well prepared to face them.

Many are poised to lose healthcare coverage. It becomes vitally important to optimize care for those that still have health insurance. Most health insurance plans in California, including Medicare and Medi-Cal, cover palliative care services. But few patients and providers take advantage of this resource. Policies are needed at the organizational level to ensure access to palliative care services that are tailored to the specific needs of the population each healthcare organization serves.

Within the next year before Medi-Cal eligibility changes take effect, Californian healthcare organizations should develop their own palliative care policy that create workflows for delivery of primary palliative care and referrals to specialist palliative care. This organizational policy should include eligibility criteria to determine which patients are appropriate for palliative care based at a minimum on the SB 1004 Medi-Cal Palliative Care policy. It should also include a workflow for all eligible patients to receive education in their language on palliative care. Healthcare organizations should train providers, enhanced case managers, and other patient-facing staff members on this policy. And for areas with limited palliative care specialists, healthcare organizations can partner with larger medical centers or train some of their own providers to provide specialized palliative care.

By developing and implementing palliative care policies over the next few years, healthcare organizations can expect to improve the quality of care for patients with chronic illness and simultaneously reduce healthcare expenses. The funding and reimbursement from health insurance plans for palliative care services already exist. Let’s take advantage of what we have to maximize the health of all Californians.

Charmaine Lim is a family nurse practitioner working in San Gabriel Valley, California with oncology and medical-surgical experience.