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Better Palliative Care – Aspire Health
A new and perhaps unique health care service is now available to those who are in need of palliative care services. Palliative care is defined in this way :
Palliative care (pronounced pal-lee-uh-tiv) is specialized medical care for people with serious illness. It focuses on providing relief from the symptoms and stress of a serious illness. The goal is to improve quality of life for both the patient and the family. Palliative care is provided by a specially-trained team of doctors, nurses, social workers and other specialists who work together with a patient’s doctors to provide an extra layer of support. It is appropriate at any age and at any stage in a serious illness and can be provided along with curative treatment.
Its target beneficiaries are those people who are seriously ill, who are not ready for hospice care but might require ER visits or long hospital stays. These visits can be costly; frequent doctor visits which may not identify underlying health issues can also be expensive. To fill the gap between conventional health needs and hospice care, Aspire Health Care has stepped in to assist patients, insurance companies, and doctors in meeting the needs of all parties concerned.
This start-up company was co-founded by former Senate Majority Leader William Frist, who is also a transplant surgeon. I see a number of ways that Aspire’s services can be helpful. [I have no connection to Aspire at all, but want people to know about these kinds of care.] This is how Aspire describes its services:
Aspire Health provides specialized medical care for patients facing a serious illness. Aspire’s services focus on providing patients with relief from the symptoms, pain, and stress of a serious illness. The goal is to improve quality of life for both patients and their families. Working together with a patient’s primary doctor, Aspire’s clinicians manage symptoms such as pain, shortness of breath, fatigue, constipation, nausea, loss of appetite, difficulty sleeping and depression. Aspire’s services help patients gain the strength they need to carry on with daily life and tolerate medical treatment, navigate the healthcare system, and make difficult and complex treatment choices. Aspire’s providers also provide patients and their family with the emotional and spiritual support that is critical in these challenging situations.
In an article in the Wall Street Journal, the financial benefits were clear:
Hospitals that offer in-house palliative-care programs find that they save an average of $7,000 per patient, according to the National Palliative Care Research Center. The handful of hospitals that provide palliative care in patients’ homes can save even more—as much as $2,000 a month in one study—by preventing return trips to the hospital.
Many palliative-care experts say that the need for such services is so great that they have no problem with a for-profit business model built around predicting patient’s deaths, as long as patients are not pressured to forego care.
Aspire “is filling a huge gap between hospitals and hospice. We need the mainstream health-care systems to step up and do the same thing,” says Diane E. Meier, director of the Center to Advance Palliative Care at the Ichan School of Medicine at New York’s Mount Sinai Health System.
The procedure for predicting patients’ deaths might be controversial to some; it is the algorithm that Aspire has developed which can predict whether a patient is likely to die in the next year. Millions of dollars are spent in the last year of a person’s life that often do not extend patients’ lives and can even put them through needless suffering. Although patients and their doctors are free to choose those options, Aspire can provide helpful input about the pros and cons of a treatment, and even offer other options that might reduce a patient’s suffering.
Some people might claim that doctors should be handling these kinds of issues. The truth is, for any number of reasons, they often don’t. And the patient and caregiver are often unfamiliar with the kind of treatment, follow-up and monitoring that should be done.
Some insurance companies are already partnering with Aspire due to the obvious cost-savings. Doctors are able to treat more patients with less complicated conditions, knowing that their seriously ill patients are being monitored. Brad Smith, Aspire CEO explains how Aspire works, as described in the same WSJ article:
“We help patients understand that they are sick and getting sicker, and we describe what we do, rather than put a label on it.” That includes a complete in-home assessment of their physical, emotional and spiritual needs, and then regular visits from nurses and social workers as well as a nurse practitioner on call 24/7—all at no cost to patients.
A key part of the program is discussing patients’ individual “goals of care,” including what treatments they want and don’t want. “We emphasize that not wanting to go to the hospital anymore doesn’t mean you’re giving up,” says Tiffany Lunsford, a nurse practitioner and clinical director with Aspire. “And if they do want to want to go to the hospital, we go.”
Aspire has an FAQ page where some of your additional questions may be answered.
Bill Ellsworth, an 83-year-old former Navy engineer with a long history of heart problems, says that he enjoys the twice-monthly visits from his Aspire nurse practitioner, but scoffs at the notion that a computer program thinks he’ll die in the next year. “They’ve been giving me two years to live since 2003,” he says.
“Occasionally we’re wrong, and we couldn’t be happier,” says Dr. Thimons.
I’d like to know what you think about this new type of service. What other upsides do you see? What are the downsides?
Published in Healthcare
I really had no idea this service existed. Thanks Susan.
thanks so much for this.
I loved your article. TY for all the research. My opinion is that this model of medical care was inevitable once managed care became the health care model in most of our country. As we move toward universal health care and lose more highly skilled physicians the hospice based treatment is the only substitute left to us. At least it will make us feel good emotionally.
One of my all-time favorite stories is about Art Buchwald. He went into hospice and came back out again after a year and wrote another book: Too Soon to Say Goodbye.
More than that, we are not seeing new physicians come into healthcare; it’s not the popular field it once was. My hope is that a universal health care will not appear, or that it will be minimal, but we’ll still need some action to replace the doctors. Thanks, Sweezle.
In effect, people “leave” when they’re darn ready! We can use algorithms all we want, but the human will is indomitable with some people! Thanks, Marci.
I am suspicious of any palliative efforts as I expect insurance or government to require them. The best way to reduce costs is to convince your patient to die
I assume you are trying to be clever (which your comment is not), but if you are serious, please elaborate.
I had never heard of it either. What do I think of it? What’s to complain. Sounds like a good thing. Thanks. And Susan, you write some of the more interesting posts.
Thanks, Manny. I guess the only part I’m nervous about is the algorithm. I’d worry that patients might learn they had one year or less to live and give up, even though they are probably told they can defy the odds. But I think it’s fabulous. I have a friend who is quite ill, and I suggested that his wife, a dear friend, look into it. And one never knows when his or her own life may take a difficult turn for the worse. It’s good to be prepared.
Susan, I am SO glad you posted this. These groups are my peeps! I have been involved in this work since the late 90s. And though I don’t do much clinical work anymore, it ranks at the top of the most energizing and rewarding work I have done.
In my research we are examining why doctors (oncologists in particular) are so reticemt to refer to palliative care.
Large randomized trials have shown that early palliative care (consultation provided within 8-12 weeks of diagnosis Of meta-static disease (cancer that has spread beyond where it originally occurred)) resulted in patients living with less pain, physical symptoms (shortness of breathe, fatigue) as well as a depression and anxiety. But those findings weren’t why we now have new Oncology guidelines.
The patients who received early palliaitive care lived (insert dramatic pause or drum roll) 3 months LONGER! Trust me, if a drug did that, headlines would have spread al over the world. The original results in meta-static non-small cell lung cancer have been replicated in other cancers as well.
In addition to providing an extra layer of support, the palliative care teams will work with the family and friends (at the patients request) to update them and help them find support or resources they need!
This is not about death panels or assisted suicide. It is focused on managing symptoms effectively and helping patients and their families engage in the activities they desire despite serious illness.
I should also point out the while mybwork has been in cancer, palliative care is also an important part of geriatrics, and various groups I work with are working to increase utilization in illnesses such as dementia and congestive heart failure.
Stoppingnow, as I fee like my enthusiasmay carry me too far!
Count me contrarian — please see bolded words above as a starting point to understand why. Having cared for a two seriously ill patients directly, and one indirectly — I see beyond the sales pitch. Let’s start with a few other definitions:
pal·li·a·tive
adjective: palliative — (of a treatment or medicine) relieving pain or alleviating a problem without dealing with the underlying cause.
Synonyms: soothing, alleviating, sedative, calmative; for the terminally ill
noun: palliative; plural noun: palliatives — a palliative remedy, medicine, etc. Synonyms: painkiller, analgesic, pain reliever, sedative, tranquilizer, anodyne, calmative, opiate, bromide
Susan is there any chance the pharmacology industry is involved in this new venture? It would be interesting to “follow the money”.
I also wonder if the best way to deal with emotional challenges is to medicate ourselves into mindlessness. IMHO, nothing is at no cost when making decisions about “life”.
For the record, my initial contrarian cynicism/suspicions were prompted by a secular organization claiming to be the appropriate helper of people facing spiritual challenges? That said, I will give credit for a clever sales pitch. My mind is triggered to recall another clever sales pitch — naming abortion clinics: Planned Parenthood.
Aspire? Early hospice for the ignorant, burdensome non-elites
I am stating that I am worried that something that is freely chosen by patients now, will become mandatory in the fine print of insurance plans in the future. Back in public health school, there was a fair amount of talk on cost control. If we don’t get rid of Obamacare, I expect that the unconnected elderly will have no other options but palliative care to avoid running up bills. I don’t think Aspire is staffed with sociopaths or heartless bureaucrats, but the people following their lead might not be as noble.
As for the comment about convincing patients to die, it is just the nature of health insurance. Health insurance loses money on people who are sick for long periods, and they have to make the money on healthy people and or those who die quickly.
Lynne, you are doing extraordinary work! Palliative care is so important and yet it is virtually ignored. Thank you for that work and for your enthusiasm!
First, I’ve always had the impression that Bill Frist was a highly respected surgeon and senator. Second, there are many treatments besides drugs for pain and discomfort, many kinds of meditation and exercise. Third, I think that the spiritual side of treatment is often ignored; to find the level at which people need comfort is a noble and just goal. I’m sorry you are cynical about this idea. I couldn’t find anyone criticizing what they do in my research. And I think they fill a need that is desperately needed. At the same, time it’s a good idea to look at these kinds of organizations with a critical eye.
Thank you for clarifying, OP. I think there is a misunderstanding of palliative care. I’m not clear on why it sounds so insidious to people. The idea is that with palliative care, people will go through their diseases with a minimum amount of pain and suffering. It does nothing to speed up or slow down their dying. They are only provided drugs if they are in serious pain, and they can decline drugs for pain if they so wish. The focus is on the patient’s needs and desires. It isn’t a substitute for other kinds of treatment; in fact, Aspire can assist people in finding the most practical ways to deal with their conditions. As this occurs, costs tend to go down. I have a number of people in my life who went through devastating, needless, painful treatments that made no sense, given their conditions. Doctors weren’t communicating with each other, patients were stuck in hospitals longer than they needed to be–the list goes on. I think that Aspire’s work needs to be evaluated in terms of the entire spectrum of services they provide.
Susan, I can assure you of the following things:
No one is making a huge profit off palliative care. Many programs (thought probably not Aspire) are funded through philanthropy.
Palliative care did not start with PHARMA.
While cost savings are often talked about, they aren’t the focus of palliative care teams. Helping patients and their families articulate their wishes and understand their prognosis and disease process is a key component, as is helping them achieve the goals they have given their current level of functioning (e.g., a trip, attending a family event).
Cost shifting is a more accurate term, as costs are shifted from ICU/acute care to care delivered in the home if that is where a patient prefers to be located.
Patients have the right to decline recommended consults. Doctors frequently don’t refer, so patients who want these services or want to evaluate the opportunity to have them are denied that opportunity.
Also, a palliative care team helps a patient get the care they want. It that is aggressive care to the last possible moment of life in a costly, acute care setting, then we work to support the patient and family while they are getting that care.
Like you, I’m suspicious about anything that’s mandated as a “have to.” I prefer professional society guidelines and options. The patient-centered care movement is all about this perspective.
I have some issues with public health professionals*, I work hard to give them the benefit for the doubt, but I think the field suffers from a couple of flaws:
*broad statements that reflect general trends, and not meant to demean any specific individuals
I was hoping you would chime in, Lynne. This is still relatively new to me, and your background information is invaluable. Thanks!
PsychLynne, I agree that aid and support provided during Hospice is incredibly important. Our assistance came in the form of palliative medical care, personal care and light housekeeping. Spiritual matters were left to the person’s family/church. I have no issue with palliative medical care during Hospice. Although, one thing of importance to me, was that it was the individual who made the decision to begin Hospice care, not the insurance company. Cost was never part of the decision process. Also, the person already knew they were seriously ill , so they did not need a third party to explain this to them.
Regarding Aspire, it is their “tone” that bothers me. Also, who decides to use Aspire or similar company prior to beginning Hospice care — the individual or the insurance company? Just wondering, do you have an opinion about why they think it is not helpful to give a name aka label to what they offer.
I recognize and value your insights on the provider side; my concerns developed from being on the caretaker/recipient side. Again, I am grateful for the Hospice care my loved ones received, but just how early in the illness/condition process do we want to start palliative care in lieu of traditional medical care? One of my relatives was given a prognosis of certain death (less than 1% survival rate) by more than one doctor six years ago. We stayed with traditional care — he is still breathing, and enjoys a quality life.
Lynne may also choose to answer, but you are ignoring the definition of palliative care and merging it with hospice. They are not the same. Palliative (if you read the definition I provided) says nothing about end of life, hospice, or anything of the sort. It is only for people who have serious illnesses. It doesn’t necessarily change anything about their treatment or care. Cost is not part of the decision process. It is a practical outcome of using Aspire’s services. Aspire is simply there to be a consultant of sorts for those families who are having difficulty finding their way through the red tape of care and treatment. No one is required to use it. The insurance company doesn’t decide that people use it or not; the action is initiated by the patient. They probably are not giving it a name yet because people will read all kinds of things into it, just as you have imposed your perceptions of dangers that aren’t there. By the way, hospice can provide spiritual guidance, if the patient or family is interested. You may not have wanted it, but many families interface with a chaplain. Also, palliative care is available from the beginning with hospice–anything that is done to make the patient more comfortable is palliative care. (Again, read the definition.) So the person you took care of was probably receiving some kind of palliative care at the beginning of hospice, or at the very least it was available to them. Just so you know, Lynne is the expert here but I’ve been a hospice volunteer for over ten years so I’m not completely uneducated in these things.
One more thing: it isn’t unusual for families to try to hide a prognosis from a patient. Families themselves are often in denial. I’ve worked with patients who were on hospice care but were still mobile and active. And some lived much longer than six months. These are all complexities of the health care of patients that must be dealt with.
Both of my parents were under hospice care. I spent hours every day over six weeks with my father while he was receiving hospice care.
Relevance? I said nothing about Frist. This reads as an appeal to false authority; his reputation does no have any relationship to my concerns.
Did not say there aren’t. For the record I agree exercise can be helpful in many situations
By whom? Why? Whose business is it?
For whom? BTW, I did not say it wasn’t. However, I think it is an individual’s domain to decide this.
Don’t be.
Relevance? Or, is this an attempt to invalidate my concerns? That is, since you know of no other persons with concerns, mine must therefore lack legitimacy? Because, just saying, not knowing of any other
criticismconcerns does not mean than no other exists.Got it. Just to be sure are you advocating for the concept or the company Aspire.
Agree.
I guess I still can’t understand where you are coming from, TT. I made the comment about Frist because I believe you are concerned about insidious forces creating this business only to make a buck. There are people who create reputable and compassionately-oriented businesses and they aren’t set to take advantage of people. I’m also glad that you believe you are capable of working your way through the mire of decision-making and difficulties without the type of assistance that Aspire provides. I think at these times not everyone has the ability or resources to make these kinds of decisions, and would welcome some guidance; final decisions are still always up to them. I have dear friends who are very competent, and when I told them about Aspire, they were very interested. Trying to figure out when and which questions should be asked has been a nightmare for them. I mentioned that I couldn’t find criticism in the media, but not to invalidate your concerns; if bad things were happening, they could certainly try to hide it, but there was nothing in public view at this point that would lead me to be concerned.
I wrote about Aspire because it is a new type of business, and I didn’t know of other businesses who provide this type of service. I thought it would be helpful for people to at least know these types of services are available. If people find another company that provides these services, that’s fine with me. And if they don’t need them, that’s fine with me, too.
Please provide the medical dictionary source for your definition of “palliative care”.
Susan, I wanted to discuss the OP, not me, but for the record, since you continue to have more to say about me than the OP, take note: I am not ignoring anything besides false accusations.
In summary, I choose to conclude with the most positive response I can summon to your insistence on making this exchange personal and about me: We are talking past each other.
This exchange having been reduced from discussion to an unpleasant argument, I will now exit your lawn.
Since I assume that Temp Time has left, I would like to say to the rest of you that I do agree with her about one thing: we were talking past each other. Also, the definition of palliative care came from a palliative care organization (link is included in the OP). Finally, I didn’t perceive our discussion as an argument, but as an effort to get clarity. I apologize to any of you who might have felt that I was making false accusations, too. I certainly don’t want others who have concerns about Aspire to worry that they are will be attacked by me.
Hi @temptime
You make some great points, adn I’m going to try to work my way through them. Pardon me if this gets long and garbled.
Hospice is a subset of palliative care. Because of payment issues, hospice can only be paid for through Medicare with the estimated prognosis is 6 months or less. Many people benefit from palliative care prior to that period (particularly since most patients spend less than two weeks). Palliative care provides similar services concurrent with curative care prior to this artificial line drawn by Medicare.
Also, patients can decline palliative care (many do), or not work with particular members of the team. When I worked on teams, we had families who either declined to discuss spiritual issues because they had a pastor or priest they were close to. We were happy they had the care. Our chaplains were most used were by those patients or family members who did not have a religious or spiritual home (so to speak).
I am glad the person knew the seriousness of their illness. My clinical experience and research both indicate that patients can be told their cancer is advanced and there is no cure, and then say the treatment they are receiving will cure them. It’s not about saying “don’t you know how ill you are?” and more about “given your illness, what symptoms can we help manage so that you can do the things you are able?”
The patient decides to accept treatment that is offered. Other insurance programs already have similar work in place under different names. It is in their best interests to have satisfied customers, and patients whose symptoms are well managed and whose functioning is maximized are happier. The name/labeling piece likely comes from the problem of people saying “palliative care – I’m not dying” or “I don’t want to talk to the death squad” or the misconception that palliative care is hospice care…rather than the conception that hospice is a subset of palliative care.