This Report Card demonstrates continued steady growth in the number of hospital palliative care programs in the United States. Access to palliative care remains uncertain, however, and depends upon accidents of geography. Millions of people with serious illness still do not receive the care they need. One-third of hospitals report no palliative care services of any kind, and access to palliative care in community settings (home, nursing home, assisted living) is limited for people who are not hospice eligible (actively dying).
Palliative care is a rapidly growing medical specialty aimed at improving quality of life for persons with serious illness and their families. Although palliative care is associated with better quality of care and lower costs, access to it is currently limited mostly to hospitals and, for those who are dying soon, hospice. Making palliative care available to the much larger population of the seriously ill who are neither hospitalized nor dying in the community settings where they receive care is the single largest opportunity to improve value in the U.S. health care system. Patients and families coping with serious illness want and need access to the quality of life that palliative care provides.
The timing, demand and opportunity to expand access to palliative care are unprecedented. The public and private health care markets are under pressure to provide higher-quality care for the growing number of aging Americans who face serious and chronic disease. The emphasis on coordinated quality care has stimulated interest among private insurers and health care networks in solutions that are person- and family-centered and have proven cost effectiveness. Public and private health care payers are moving away from fee-for-service siloed payment systems that confound the ability of hospitals, doctors, nurses and other health care providers to coordinate the care they give their patients. Payment changes based on quality of care are pushing communities and health systems to work together to reorganize how and where care is delivered, to reach patients where they live and not just in the hospital. This new environment has led to widespread recognition by payers, providers and other influential stakeholders that palliative care is an evidence-based practical solution to improving value that can be widely implemented. Key stakeholders, including the Institute of Medicine, have recognized a need for additional training in palliative care for most doctors and nurses based on the value this care provides to patients and their families.
Barriers to palliative care access remain in three key areas: workforce, research and payment models linked to quality measures. Recommendations for federal policy actions are made on the following page.
Lawmaker interest in promoting wider patient access to palliative care is growing. Widely supported legislation pending in Congress would facilitate research, professional development and public education in palliative care. In addition, numerous state governments are developing new initiatives and passing supportive legislation.