Accountable Palliative Care Organizations (APCOs)

From time to time, clients inquire if there is a single factor which keeps communities, in general, and hospital/health systems, specifically, from realizing the full potential of palliative care. Our analyses of the Dartmouth Medical Atlas suggests to us that HOW communities are ORGANIZED to deliver and distribute palliative care may be the single most important determinant of success.

Drawing a composite picture of a hospital’s (and community's) palliative care performance from palliative outcome indicators can reveal lots about performance in meeting the needs of those with advanced illness. Our study of better-performing communities identifies several attributes shared by these exemplar palliative care communities (much has been written recently about one of these Exemplars - LaCrosse, Wisconsin). These shared attributes are:
• Multiple Points of Patient Access
• Multiple Sources of Reimbursement and Mechanisms to Enable Internal Pricing and Transfers
• Chief Palliative Care Officer
• Protocols/Tools Span Settings of Care
• Relentless Collection of Data and Focus on Accumulating and Disseminating Knowledge of Best Practices.

We refer to virtual structures possessing these attributes as Accountable Palliative Care Organizations (APCOs). In coming posts, I'll offer more detail on why these attributes matter, and why APCOs are so difficult to develop. In the meantime, I'm curious to learn your thoughts, and how your assessment of current late-life care practices in your communities confirms or refutes this organizational model.

Advanced Palliative Care Organizations -An Organizational Model to Distribute Palliative Care

Hospices are especially adept at managing patients close to the end-of-life. My study suggests there are two reasons - because the number of such patients that hospices serve is so large (more than 50% for many hospices) AND because the most challenging patients (clinically and financially) are those with lengths of stay of 10 days or less. Several research studies have found that the most costly periods of care, under the hospice benefit, are the FIRST five days of enrollment on the hospice benefit and the LAST five days of life. So it's natural to expect that hospices will become proficient in managing "short-stay" patients.Currently, palliative care in this nation is organized, and thus delivered, around the hospice benefit. No question, greater accessibility to better end-of-life care has resulted since Medicare introduced the hospice benefit. I believe most of us would agree,however, that palliative care applies to many more patient populations than those fast approaching end-of-life. How can we best assure that chronically ill populations benefit from palliative care? By reorganizing, around Advanced Palliative Care Organizations, how health care is provided to those with life-limiting diseases.