When it comes to health care, the saying “you get what you pay for” doesn’t always apply. Sometimes, particularly in the realm of end-of-life care, “less is more.”

National health care reform is realigning the fee-for-service system and holding providers accountable for needlessly escalating costs. For example, Medicare has instituted penalties against hospitals with patient re-admissions within 30 days of discharge. Patients with chronic illness in their last two years of life account for a third of total Medicare spending.

The Affordable Care Act as it applies to our care is a step in the right direction for patients. The goal is improving care and patient satisfaction while reducing costs.

Hospice of the Valley established the Arizona Palliative Home Care (AZPHC) program to care for these late-stage chronically ill patients who aren’t on hospice but could be within two years. Palliative care is delivered in the home setting by a team of health care professionals who address each individual’s physical, psychological and spiritual needs.

Services include case coordination, patient education, medication management, nursing and social work assistance.

Unlike hospice patients, AZPHC patients may be receiving curative treatment from community doctors at the same time as palliative care. With AZPHC as their anchor, patients have reported a greater sense of well-being. Some improve and are discharged from AZPHC while others eventually transition to hospice. Their utilization of hospital emergency rooms has plummeted.

We’ve shared this positive news with insurance plans, several of which have contracted with AZPHC to care for their sickest patients. Those contracts have provided a revenue source for this innovative donor-funded program. Our home health program also has been enhanced to care for additional home-bound patients not on hospice.

Ultimately, we believe Medicare will cover palliative care just as it does hospice and home health care. Palliative care should be provided throughout the course of a chronic or serious illness — not just at the end.

We’re pleased to be at the forefront at this important juncture in health care. Though change is constant, we are always guided by our mission — bringing comfort and dignity as life nears its end.

We continue to be humbled by the privilege of doing this work.

• Susan Levine is executive director of Hospice of the Valley, the nation’s largest not-for-profit hospice, serving central Arizona, including Ahwatukee.

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