Palliative teams are sometimes met with doubt by both patients and their medical colleagues. Dr. Timothy Quill, a palliative care doctor at the University of Rochester Medical Center and president of the American Academy of Hospice and Palliative Medicine, concedes that patient recognition of what palliative care is remains relatively low and that resistance to the field remains among doctors untrained in the field.
Aside from misconceptions about palliative care being non-curative pain relief for patients destined to die, specialists may find a palliative team helps a patient reach a treatment decision that doesn't offer the most payment. Quill offers an example of a heart failure patient who may be considering getting a ventricular assist device.
"The economic incentives clearly favor doing aggressive medical interventions like this," Quill said. "Palliative care, it's all conversation. And conversation is not compensated in the same way that doing procedures is in our system right now."
Meier says resistance to palliative care tends to be generational, with many younger doctors embracing the field. Research on the subject has also helped prove its worth, particularly a 2010 study published in the New England Journal of Medicine.
That widely publicized report looked at terminal lung cancer patients and found patients who received palliative care as soon as they were diagnosed were in less pain, happier and more mobile than those who didn't receive such care, and the patients ultimately lived nearly three months longer.
Even with such scientific backing, and generally rave reviews from patients, even palliative care's most ardent backers admit it would not have spread as it has without showing cost savings to hospitals. Because a result of palliative care is shorter hospital stays, it can cut costs since many insurance plans pay a flat reimbursement for a treatment, not for the length of stay.
If a bed is freed up sooner, that means another paying customer can occupy it.
"By itself, better outcomes for patients would not be enough," Meier said. "In our society and current way of life, it is impossible to introduce any innovation whether it's surgery or drugs or any innovation if you can't show that it doesn't increase costs."
Broward General's adult and pediatric palliative teams saw more than 1,300 patients last year, but so far administrators have had trouble quantifying what the precise financial impact has been. Sutton and her colleagues have little doubt their work has resulted in fewer hospitalizations and shorter stays, but have found it hard to pinpoint the savings.
Sutton is focused this day on Delzatto, asking her about her sleep and bathroom patterns, and addressing her pain by writing prescriptions. Before seeing Sutton, the patient said she was suffering so greatly she was barely able to move. Now, she's able again to live fairly normally, browsing garage sales with a neighbor and walking the mall with her husband.
"The oncologists are focusing on chemo, the patients are focusing on cure and I think the conversations about comfort aren't happening," Sutton said.
Much of the appointment, Sutton just sits and listens, to Delzatto talking about her Mother's Day celebration, her new Kindle Fire and how she hopes to be able to go on a cruise later this year. And she hears Delzatto credit her with making her life livable again.
"They need more of you," she said.
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