Health care reform: Opportunities and challenges in palliative care

Opinion leaders in the field of palliative medicine explored the unparalleled opportunities that now exist for the palliative care community, which matches treatment to the desires of informed patients and their families, to help define evolving health care reform policy. The thought-provoking Roundtable discussion, "Palliative Medicine: Politics and Policy," is published online ahead of print in Journal of Palliative Medicine, a peer-reviewed publication from Mary Ann Liebert, Inc. (www.liebertpub.com). The Roundtable is available free online at www.liebertpub.com/jpm

The moderator, Diane E. Meier, MD, from the Center to Advance Palliative Care at Mount Sinai School of Medicine, in New York City, led a lively discussion focusing on the need to change public perception of palliative care and to educate the public and policymakers on how palliative medicine can contribute to improved quality and greater cost-effectiveness of health care, two of the cornerstones of current health care reform efforts. In October 2009, Dr. Meier began a health policy fellowship in Washington, D.C., with the goal of learning how process and politics influence health policy.

Participants in the Roundtable included David J. Casarett, MD, from the Philadelphia Veterans Administration Medical Center and the University of Pennsylvania, Charles F. von Gunten, MD, PhD, Editor-in-Chief of Journal of Palliative Medicine, and Provost, Institute for Palliative Medicine at San Diego Hospice (California), Walter J. Smith, SJ, PhD, from HealthCare Chaplaincy (New York City), and C. Porter Storey Jr., MD, from the American Academy of Hospice and Palliative Medicine (Glenview, IL) and Colorado Permanente Medical Group (Denver).

The discussion explored the successful approach to end-of-life care in the Veteran's Administration health system and how it could serve as a model for the nation. The participants urged the palliative care community to be more proactive in promoting education and awareness, initiating a public conversation and countering misinformation, and demonstrating to politicians and stakeholders how palliative medicine has an important role in policies aimed at improving outcomes and linking evidence-based quality measures to reimbursement.

"Health care reform in the U.S. has put palliative care issues at the forefront of policy and politics as never before. As with all change, there are both opportunities and challenges. This roundtable discussion by national experts illustrates some of the nuance that is missing from the media reports," says Dr. von Gunten.