How can Virginia aim to increase utilization of appropriate palliative services and hospice care for patients with advanced illnesses? For starters, access to these services must be available to all Virginians. To increase access to palliative care services, Virginia should look to the versatile physician assistant (PA) profession to fill voids where there is insufficient staffing and access to palliative care clinicians.
At the end of my first fall semester of PA school, I had the opportunity to discover the value of palliative services and hospice care when my grandfather sustained a serious injury to his heart. I saw firsthand that these services allow patients and their families to navigate serious illness and holistically cope with death. At the time, I didn’t know how lucky I was to be served by a hospital system that offered access to this interdisciplinary team of medical providers.
Prior to this experience, I did not fully understand the need for palliative services and hospice care. For starters, I did not appreciate that these were somewhat separate domains. As I learned palliative care is not synonymous with hospice care. Palliative care is an interdisciplinary medical subspecialty that integrates treatment of a patients’ physical and psychological symptoms with the support of their spiritual needs while enhancing patient-to-provider and provider-to-provider communication to establish continuity of patient care within the healthcare system. The support and coordination of palliative care can be utilized at any stage of a serious illness, at any age, and at the same time of curative treatment. Hospice care is a delivery system that provides palliative care under the Medicare hospice benefit and is offered to patients when medical therapies cannot offer a cure.1
Palliative medicine is a rapidly growing subspecialty as its collaborative interventions have been shown to reduce patient symptoms and improve their quality of life while minimizing health care expenditures for patients living with serious illness.1 In 2015, Virginia ranked 20th in the nation for the availability of palliative care services in U.S. hospitals, per The National Palliative Care Registry. 2 At that time, this organization estimated that about 77% of the Commonwealth’s hospitals had access to a palliative care team, which earned Virginia a “B” on the report card for access to palliative care.2 Like other states across the nation, Virginia’s largest deficit in palliative care services was in suburban and rural hospitals with fewer than 150 beds.2 According to data from the 2010 census, nearly 25% of the Virginia population live in rural areas, this equates to roughly two million citizens lacking local access to palliative care services.3 Further, this does not account for those Virginians living in suburban areas that may be served by hospitals with less than 150 beds. These hospitals often lack palliative care teams because there is a shortage of trained clinicians.2
Patients with serious illnesses need health care and medical options that support them during their most vulnerable and fragile stage of life. PAs are capable receiving on-the-job training from palliative care physicians, just like PAs working in other specialty medical fields, which enables these skilled medical professionals to fill roles on palliative care teams. Utilizing PAs expands appropriate access to needed palliative care services. This was recognized on February 9, 2018, when the United States Congress passed, and President Trump signed into law the Medicare Patient Access to Hospice Act. Effective on January 1, 2019, this law will allow PAs to manage and provide hospice care to terminally-ill Medicare patients (personally, this is convenient as I graduate from PA school in December 2018 and will be looking for a job!). While PAs have been filling needed roles in palliative care for years, this law bolsters career options for PAs as employers can now fully utilize these trusted health care providers as members of palliative care teams.
As Virginia policymakers and healthcare industry leaders seek to innovatively increase patient access and utilization of high-value health care they should look to PAs to fill gaps where shortages of clinicians exist – in suburban and rural areas served by hospitals with fewer than 150 beds. PAs are nationally certified and state-licensed medical professionals who are trained in the medical model to diagnose, treat and prescribe medication as devoted members of patient healthcare teams. As certified medical generalists, with a foundation in primary care, PAs can fulfill the need for palliative care providers in Virginia.
Blake Rogers, VCHI Innovation Fellow
1. Kelley AS, Morrison RS. Palliative care for the seriously ill. N Engl J Med. 2015;373(8):747-755. doi: 10.1056/NEJMra1404684 [doi].
2. Virginia: Palliative care in your state’s hospitals, 2015 Report Card. The National Palliative Care Registry.
3. U.S. Census Bureau, 2010 Census of Population and Housing, Population and Housing Unit Counts, CPH-2-48, Virginia U.S. Government Printing Office, Washington, DC, 2012