National Palliative Care
HOSPICE AND PALLIATIVE CARE
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10:01 AM -- The committee took a brief recess.
10:09 AM -- National Palliative Care
The committee reconvened. Porter Storey, Executive Vice-President, American Academy of Hospice and Palliative Medicine, Kaiser Permanente, introduced himself. Dr. Storey spoke to national palliative care issues. Dr. Storey provided a power point handout to the committee (Attachment C). He reiterated testimony from Dr. Cordt Kassner stating that most patients prefer to die at home, yet most people die in hospitals. He stated that he envisions that in the future a majority of hospitals will have a palliative care unit as palliative care improves the quality of life for the sickest and most vulnerable patients. He stated that nearly 1,100 hospitals nationwide have a palliative care program, a 63 percent increase since 2000. Dr. Storey stated that a study was conducted that showed there was a direct correlation regarding the number of people who die at home and the number of hospital beds in a given area stating that the study revealed that the higher the number of hospital beds related to the incidence of death at a hospital.
Dr. Storey spoke about multi-disciplinary teams, clinic-based, inpatient, and home-based teams. He stated that the fragmented system does not allow all health care models to have these multi-disciplinary teams, but the model of multi-disciplinary teams works well for the patient. He spoke about various programs, such as Advanced Illness Care Coordination, which aims to address issues sooner rather than later for a person who may not be terminally ill, but has a chronic illness. He stated that these people typically are in need of care, but that the care can occur outside of a hospital. He spoke to the cost savings of these programs.
Dr. Storey spoke to the access of analgesics or specific types of pain medication. He stated that the federal Food and Drug Administration (FDA) sent a letter to manufacturers of certain opiate drugs that doctors will be required to have a Risk Evaluation and Mitigation Strategy (REMS) for the purpose of evaluating whether the drug prescribed outweighs the risk factors of prescribing that certain drug. He explained that the letter emphasized the FDA's concern that many teenagers were becoming addicted to these types of drugs. Dr. Storey stated that the REMS requires doctors to sign a registry and certify their training regarding dispensing these types of drugs. He stated that this could significantly affect patients that are in pain because not all physicians are certified and may not be able to prescribe the pain medication to patients. The committee discussed potential solutions to the issue. Dr. Storey stated that stakeholders are meeting with the FDA to formulate a plan in reaction to the proposed rules in the REMS. The committee also discussed the deposit of drugs that are not completely used.
The committee took a brief recess.