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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
Been there as a family member and a friend, both with and without. It is a difficult path to walk.
A commonly used technique for referral, that’s actually been validated is the “surprise” question. A provider asks “would you be surprised if this patient died in the next year?” if the answer is no, then a palliative care consult should be considered. Some systems have a palliative care consult if a patient is in the ICU more than 5 days. In oncology, new guidelines state that a palliative care consultation should be offered (again, not required) by any patient with an advance cancer diagnosis (Stage 3 or 4) or if there is a significant symptom burden or poor symptom control.
The beauty of palliative care is that is can be offered alongside curative or traditional care; while hospice (due to Medicare guidelines) cannot. And your story illustrates two important things: how much we don’t know about prognosis, particularly those who don’t follow typical patterns; and how personal experience and stories are more persuasive than data ; )
great answer!
Part of the issue with public health is that it is a larger field than what people generally are aware of. It has four sectors, generally:
Epidemiology / Biostatistics – probably the most respected branch. Hard numbers, data analysis, and a bit of the sleuth. If you have read any of Berton Rouche’s work, like The Medical Detectives, it is all here. Every public health professional learns the basics of epidemiology (outbreak investigation, incidence vs prevalence, etc)
Community Health Sciences – the classic image of public health. Encouraging healthy behaviors, education, etc. Very not my cup of tea, but it is useful. (I like to post the Keep Calm and Wash Your Hands posters at work) They are the people who tend to lean toward treating people like wayward children to be educated and corrected. Remember, they do not treat a patient, they treat a population.
Health Policy & Administration – Health care bureaucrats. (Though one professor actually talked about conservative arguments, even mentioned the Nanny State. Nearly fell out of my chair) Very focused on health care as a system, but surprisingly little grounding in finance or economics, as you said.
Environmental & Occupational Health Sciences – OSHA and EPA folks. This is where I was at. Much more client-service focused – “How do I make X workplace safe?” “What risk does this pollution pose to the local area” etc.
Thank you for filling out the picture and telling us your role in it, OP. I just want to emphasize that patients should not suffer because someone wants to “nurse” the bottom line. I think we are in agreement on that. Power to the patients!
I really like that rubric
That’s not my work, that’s how the field is broken down in college. Those are all majors you can have while pursuing a master of public health (MPH) degree. People tend to follow that rubric in later careers.
EOHS overlaps with safety engineering and the technical side of safety, as well as occupational medicine. There’s also an overlap with environmental science – modeling atmospheric / aquatic distribution of agents, for one.
I’ll still say that Epidemiology is the big dog, since it ties in with study design and how we know about effects in large populations. There’s a reason the classic public health story is the outbreak investigation that traced cholera back to a contaminated pump. (Though the EOHS side of me will say that is actually an environmental hazard…)
@susanquinn
SQ: Palliative care is a serious issue, and your post and others’ comments are insightful. I am a newbie to Ricochet, and rarely serious, but I would like to go on record to say that I am strongly in favor of euthanasia. BUT, I am also in favor of youth in America. Additionally, I have stressed to my wife to get second and third opinions about any serious, debilitating disease affecting me. She has lived with me a long time, so I suspect she has an itchy trigger finger when it comes to pulling the plug. Michael Henry
Thanks, Michael. Euthanasia is another tricky topic. I think if we change our attitudes about care and treatment, and the use of palliative care, people will die in their own time, on their own terms. Killing people is something I’m just not prepared to approve.