Health care system should focus on easing patients’ lives

(The Tennesseean, July 21, 2013)

By Senator Bill Frist, M.D., John Shuster, M.D., and Andrew Lasher, M.D.

Over the course of the past century, advances in public health and medical care have led to improvements in life expectancy that our ancestors would not have been able to imagine. Average life expectancy for Americans born in 2013 is approaching 80 years. While we now live longer and typically spend most of these years in good health, many live with advanced and complicated illnesses. Health problems that once caused death are now controllable as chronic conditions. With these chronic conditions comes the risk of chronic illness and chronic symptoms.

Our health care system is not well-suited to caring for the large and growing number of patients with multiple, complex chronic illnesses. The strengths of our system — the technology and expertise that have led to these amazing advances in survival — target specific diseases one at a time. For those of us who have a single curable or controllable disease but are otherwise healthy, this system works very well. But what about those with chronic health problems, especially when one person has multiple chronic diseases? Our current health care system is often too fragmented to be of substantial benefit for these patients.

The solution is a system of specialized, coordinated care focused on the needs of patients with complex and chronic illnesses, aimed at helping patients live as well and as long as they can, even when cure is not a reasonable expectation. This is palliative care.

The word “palliative” comes from a Latin word for a kind of cloak, so that palliation is properly understood as shielding and protecting patients from the suffering of illness. Palliative care is aimed at maximizing quality of life; minimizing suffering; and providing care, comfort, companionship and peace. Palliative care can be provided to patients at the end of life or to those who have years left to live and are receiving treatments aimed at cure and control of disease.

Patients with heart disease, lung disease, diabetes, cancer and other illnesses can live for years with controllable health problems. Palliative care uses a team of physicians, nurse practitioners and other professionals who collaborate with a patient’s other health care providers to deliver and organize care. This care is guided by the preferences and values of the patient and family and aims to help patients live as well as possible and avoid health crises that may lead to hospitalization. Care aims to minimize symptoms like pain and nausea; reduce worry, anxiety and depression; and maximize important relationships and finding peace of mind.

Palliative is provided at home and clinics, just in the hospital. Care is shaped to what patients need and want. When that care is moved to the patient’s home, complications and crises can be prevented. Patients feel better and spend more time out of the hospital, enjoying good quality of life. Health care costs go down when patients have fewer health crises that require trips to the emergency room or admissions to the hospital.

Making this care more widely available is an important step in improving our health-care system. In Tennessee, Aspire Health and Alive Hospice, the largest hospice in Middle Tennessee and one of the first hospices in the U.S., are forming a joint venture: Aspire Health Medical Partners of Middle Tennessee. We hope to bring the benefits of palliative care to more people in our community. This partnership will create a nationally scalable model for advanced illness care that can meaningfully improve the quality of care for patients facing a serious illness while simultaneously significantly reducing total medical costs.

Middle Tennessee is our home. We are proud to build this pioneering partnership here.

Dr. Bill Frist is a former U.S. Senate majority leader and currently the chairman of Aspire Health, a new palliative care company. Dr. John Shuster is a board-certified palliative care physician and the chief medical officer of Alive Hospice. Dr. Andrew Lasher is a board-certified palliative physician and chief medical officer of Aspire Health.

This article was originally posted in The Tennesseean