Can You Afford to Offer Palliative Care?

Neil Chesanow


March 26, 2013

In This Article


Palliative care has been practiced at least since the Middle Ages, but it is not yet frequently integrated into office-based community oncology practices, as a growing number of cancer experts now think it should be if patients are to receive optimal care.

Palliative care in this context does not refer to "primary" palliative care, which medical oncologists are trained to perform, but rather to "secondary" palliative care to manage the symptoms of complex patients, which is often more effective when left to an oncologist who has undergone subspecialty training, says J. Cameron Muir, MD, Executive Vice President for Quality and Access at Washington, DC-based Capital Caring, which offers hospice and palliative care services to community oncology groups. That expertise was legitimated in 2006, when the American Board of Medical Specialties recognized the competence of hospice and palliative physicians as unique and at a subspecialty level of medical practice.[1]

As awareness spreads, more practices are seeing a benefit to having a palliative medicine subspecialist on site. A patient could then see, as needed, a radiation oncologist, a surgical oncologist, a medical oncologist, and an oncologist trained in palliative care, and do it all in 1 visit, without having to go someplace else for pain and other symptom management. "The patient's comprehensive initial assessment and formulation of a care plan are done as a team," Muir explains. "Then, if possible, the patient sees that same team of doctors each time he or she comes into town."

Is this better for patients? To find out, Muir served as lead investigator in a proof-of-concept study.[2] It focused on the impact of palliative services added to a 24-physician community oncology group in Fairfax, Virginia, as well as a few other practices in the area.

Over a 2-year period, palliative care was associated with reduced symptom burden in patients by 21%. And, while some staff oncologists were initially wary of entrusting symptom management to someone else, overall provider satisfaction was rated 9 out of 10, and requests for palliative care consultations increased by 87% in the Fairfax group.

Adding palliative care isn't as costly or complicated as many doctors assume, Muir contends. He and his colleagues have worked out a solution that minimizes the expense and risk and maximizes profitability, even for a small practice. Here's how it works.


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