2020 Maine Session Summary
Victory in the fight against cancer requires bold new public policies that promote cancer prevention, early detection of cancer, and expand access to quality, affordable health care.
News
State takes big step toward more pain care
May 8, 2013
State takes big step toward more pain care
Posted: 5:24 pm Mon, May 6, 2013
By
Alissa Gulin, Daily Record Business Writer
Hospital representatives and patient advocacy groups are celebrating what they say is the first step in making high-quality palliative care programs — which create specialized treatment plans for patients with serious illnesses — accessible to all Marylanders.
Last week, Gov. Martin O’Malley signed a bill establishing palliative care pilot programs at five yet-to-be-chosen hospitals, which will then report to state regulators about best practices for implementing the services throughout the state. In palliative care, teams of medical professionals treat the physical and emotional pain that often accompanies serious illnesses and their treatments, such as the side effects of chemotherapy. Doctors also thoroughly explain all treatment options, helping patients feel more in control of their health, proponents say.
“It’s a wraparound service, usually with a team leader bringing together specialists to work with the patient and family to look at the nausea, the pain, the emotional distress of having a lifelong chronic disease,” said Bonita Pennino, a regional government relations director of the Cancer Action Network, the advocacy arm of the American Cancer Society. “There’s a lot that needs to be addressed to allow the patient to focus on getting well.”
The pilot programs are expected to begin in October, and the legislation lays the groundwork for advocates’ ultimate goal: to implement palliative care programs in all Maryland hospitals with 50 beds or more and to establish the standards by 2016. The five hospitals, which will be chosen through an application process, will then make recommendations to the Maryland Health Care Commission on developing uniform programs across the state.
That expansion could take many forms, said Denise Matricciani, vice president of governmental policy and advocacy for the Maryland Hospital Association.
Most hospitals in Maryland already offer some form of palliative care. According to the national Center to Advance Palliative Care, 37 of the 41 hospitals with 50 or more beds offer the services — but with varying degrees of sophistication and resources, Matricciani said.
A handful of industry guidelines are available, including certification standards created in 2011 by The Joint Commission, a national accreditation organization for health care providers, but they’re voluntary — and officials said most programs don’t meet them. Some don’t come close.
“Earlier, the proposal [for the bill] was to have all palliative care activities meet requirements established by The Joint Commission, but these standards were brand new and quite high,” said MHA President Carmela Coyle. “So there was concern that starting there, at that level, would actually limit our progress in developing these programs, because if the standards were too difficult to meet, hospitals would not want to put these programs together.”
Instead, the MHA worked with advocate groups to craft a bill proposing the pilot programs. After that period is over, regulators might require all hospitals to operate palliative care programs, or, if they decide to keep participation voluntary, they could still implement mandatory standards for the programs that do exist. Those standards will likely be based off the set developed by The Joint Commission, but tweaked to reflect Maryland’s unique needs and resources, officials said.
Hospital representatives agreed with Pennino that universal access to palliative care is desirable, but said it’s possible the pilot program will show some hospitals in Maryland aren’t in a position to manage their own programs. A major challenge, they said, is not having enough professionals specifically trained in palliative care to staff the programs. That issue is particularly pronounced in rural areas, but it’s also true elsewhere throughout the state and the country, as well.
“Folks want to receive care in their community, but having said that, we all need to be sensitive to health care costs,” Matricciani said. “So hopefully, one of the things the pilot will determine is what makes sense in every area of the state.”
Officials also want to determine if it’s feasible to mandate across-the-board standards that apply to every hospital. They said the state could choose to implement slightly different standards based on different factors, like the size of a hospital’s staff, rather than fixed requirements that apply to all of them.
“Everybody believes in and supports this service, but hospitals are at different levels in terms of where their programs are,” Matricciani said. “For example, in areas where there aren’t enough physicians to lead these teams, they’ve built their models around nurses. But some standards dictate [the programs] should be physician-led. So we need to see where the barriers are, where the strengths are, what the best practices are — and that is hopefully what we’ll glean from the pilot.”
Additionally, Coyle pointed out that hospitals are already financially strapped. As a group, their operating margins are more than three times smaller than what state regulators consider optimal; many of them are in the red. Coyle said mandates to comply with The Joint Commission’s strict requirements could have stretched resources even thinner and further strained their budgets.
There is no state money allocated in the bill for the pilots. The commission will absorb the costs of collecting data and reviewing the recommendations, Matricciani said, while the five hospitals that apply and are chosen to run a pilot must cover the expenses of actually providing the services. Officials said they weren’t sure how much it costs to operate a full-fledged palliative care program, but salaries are the chief expense.
“For many hospitals, there is going to be an increase in costs for implementing these programs,” Pennino said. “But it’s best for the patients, and it’s what they need.”
Yet, Pennino, a cancer survivor herself, said she still thinks the programs are a good investment.
“This is an example of legislation that’s going to save money in the long run, for hospitals and for the country,” Pennino said. “As more and more people receive palliative care with symptom management, they’re going to be discharged from the hospital sooner because they’re going to feel better sooner.”