Monday, June 14, 2010

Bellwether Hospice and Palliative Medicine (HPM) Practices

If the Hospice and Palliative Medicine(HPM) specialty is in its nascence, as widely considered, then what will the practice of palliative medicine look like five years from now? The bellwether theory offers several ideas. What, or who, are bellwethers? Simply, one who, or that, serves as a leading indicator of future trends. A bellwether stock is widely believed to be an indicator of the overall market's condition. In sociology, the term is applied to a person or group of people who tend to create, influence or set trends.

What practices might be considered as bellwethers for the HPM specialty? One might start with the practices associated with Advanced Palliative Care Communities. These are communities which score highly in the DAI Community Palliative Performance Profile. The DAI Profile uses data from the Dartmouth Medical Atlas to compile a snapshot of a community based upon its performance in an array of patient palliative care preferences. Grand Junction, Colorado and LaCrosse, Wisconsin are two Exemplar communities. A recent post on this blog had an interview with the HPM practice chief in Grand Junction.

Another bellwether is the HPM group practice which has attained “critical mass” of palliative medicine intellectual capital. What is it about these practices that makes bellwethers of them? We find that their "mass of intellectual capital" enables the "spread of science" and positions them well to take on roles as chief palliative officers of the Accountable Palliative Care Organizations (APCOs) within their service area. APCOs are virtual networks of providers whose collaboration around palliative services likely leads to higher levels of patient/family satisfaction and more efficient use of acute hospital beds. The chief palliative care officers are the integrators of these networks.

Others contend that bellwether practices are generally found in bellwether states (Florida leaps immediately to mind). Why? Because late-life care organizations (hospices, typically) in these bellwether states make greater use of HPM physicians. As illustration, Medicare data from Healthcare Market Resources reveals that Florida hospices generate revenue from physician services nearly three times that of the national average. Finally, the practices, small or large, which stand out by virtue of their chiefs. Some argue that such practices, dependent upon a single individual, have an unstable foundation and thus would not "qualify" as a bellwether because their best practices are not institutionalized.

Others counter that Accountable Palliative Care Organizations, and Communities, are often the lengthened shadow of their leaders. We’re uncertain to which view we lean. Yet, one is hard-pressed to deny the influence of these pioneers. So, until we learn that the exercise is fruitless, we’ll continue to look at these "pioneering" practices as bellwethers.

I invite your professional experiences and insights, as we explore in upcoming posts the future practice of Hospice and Palliative Medicine, as seen through the eyes of the bellwether theory.

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