Nevada makes big strides in palliative care for seriously ill

By Kyle B. Hansen

Wednesday, Oct. 5, 2011 | 8:21 a.m.

Las Vegas has a reputation for providing poor health care, but a report released today says Nevada has made significant strides in the last three years in providing one specialized service for some of the sickest patients.

In 2008, the Silver State received a D grade for the number of hospitals that provide palliative care, which is focused on making life more comfortable for people with serious and chronic illnesses.

This year, the state received a B grade, giving Nevada the largest improvement of any state, according to “America’s Care of Serious Illness: A State-By-State Report Card on Access to Palliative Care in Our Nation’s Hospitals,” which appears in this month’s Journal of Palliative Medicine.

About 90 million Americans have some sort of serious or chronic illnesses, such as cancer, heart disease, diabetes, Parkinson’s or Alzheimer’s, according to the Center to Advance Palliative Care, which is part of the Mount Sinai School of Medicine.

The center said three-fifths of hospitals that participated in a survey have some sort of palliative care services, giving the nation a B grade.

In Nevada, 69 percent of hospitals provide the service, the report said.

About half of the states received a B grade. Seven states and the District of Columbia got an A, while two states, Delaware and Mississippi, received an F.

Unlike hospice care, which comforts people at the end of their lives, palliative care helps people who may have months, years or decades to live.

The concept developed after hospice care became popular and proved effective but was limited to end-of-life services, said Dr. Warren Wheeler, senior director of medical care for Nathan Adelson Hospice and the director of Sunrise Hospital’s palliative care program.

Medicare only reimburses hospice care expenses for patients who are not expected to live for more than six months.

But doctors learned some patients with terminal illnesses will live much longer, and other patients need help managing pain, arranging their affairs and making medical decisions even if they are expected to live for a long time, Wheeler said.

That’s where palliative care comes in, bridging the time between acute care and hospice care, Wheeler said.

The results often extend the life of the patients, makes them more comfortable and lowers costs for hospitals, because the patients are sometimes able to return home, he said.

Wheeler said he often helps patients figure out to what extent they want to be treated, avoiding extra tests and lengthy stays in the intensive-care unit.

“The patient gets better care, the family is happier and the hospital (saves money), so it’s a win-win-win all the way around,” he said.

Participation in palliative care has boomed in Las Vegas in recent years.

Nathan Adelson Hospice set up a program about five years ago, said CEO Carole Fisher. The program is named for Elaine Wynn, who provided the seed money to provide service to people who can’t afford to pay.

At first, it was hard to get doctors to participate and refer patients, she said.

In 2009, the service provided just 28 consultations. In 2010, it was up to 384, and so far this year, it has provided 746 consultations, Fisher said.

“So you can see how it is really being embraced in this community,” she said.

Wheeler said he has provided 315 consultations so far this year at Sunrise alone. As the service grows, he estimates it will save the hospital more than $1 million a year.

Wheeler said he works with medical students from the Nevada School of Medicine and from Touro University who are learning about palliative programs, and doctors across the state are more interested in the service.

“We’ve all really tightened the reigns and said this is a priority and we really need to educate the medical community and the public that palliative care is here to stay,” he said.

Nathan Adelson’s service is primarily with Sunrise and MountainView hospitals, but St. Rose Dominicans Hospitals have their own palliative program and University Medical Center and the Valley Hospital Medical Center are looking into the service, Fisher said.

“Coming from a D to a B is wonderful for Nevada,” Fisher said. “It’s really showing that we respect our patients who are sick and the community members who have illnesses and that we’re committed as a community to provide better care.”