Some of the most daunting challenges to the expansion of palliative care come down to payments and people.
Despite early research suggesting there are eventual cost savings in palliative care, setting up a palliative care team does require an investment. And in a medical care system that largely rewards doctors and hospitals for performing procedures, many financially strapped hospitals ask whether and how palliative care teams will pay for themselves.
Currently, they are largely paid for by philanthropic funds and are most likely to exist in not-for-profit hospitals. The federal government’s Medicare and state Medicaid programs now pay physicians who provide palliative services. But for the most part, those giant government insurance programs (which influence the coverage decisions of private insurers) do not pay for the work of many of the workers — nurse practitioners, social workers and pastoral counselors — who deliver the most labor-intensive services that palliative care teams provide.
Finally, physicians with special palliative care training are scarce, especially considering the tidal wave of older Americans they may be called upon to treat. By 2030, 72.1 million Americans — 1 in 5 —will be older than 65 and will probably live long enough to contend with multiple medical conditions for which they’ll need coordinated care.
Palliative care didn’t gain formal recognition as a medical specialty until 2007, and today there is only one physician trained in palliative care for every 1,200 Americans living with a severe or chronic illness. A December 2010 study published in the Journal of Pain and Symptom Management estimated that the current supply of trained palliative and hospice care physicians falls somewhere between 6,000 and 18,000 short of the nation’s needs.
“There are a number of hospitals in the United States that want to have a palliative care team and are having difficulty recruiting,” said Dr. Sean Morrison of the National Palliative Care Research Center and Mt. Sinai School of Medicine. “There just are not enough trained professionals to provide this care.”