The essays, analyses and opinions presented as Community Voices express the perspectives of their authors on topics of interest and importance to the community, and are not intended to reflect perspectives on behalf of the Salish Current.

The changes recently announced to PeaceHealth’s outpatient palliative care program, currently serving 64 patients in the Bellingham community, were made in a context of significant financial challenges to healthcare across the nation, with costs growing faster than revenues. Like every unit across the PeaceHealth system with facilities and programs in Washington, Oregon and Alaska, the Home and Community division conducted a comprehensive review of our services and operations to identify where we could grow, optimize and, if necessary, reduce services.

Faced with the reality that many of the Home and Community services we all believe in are not fully reimbursed by insurance companies and require significant support that is simply no longer available from the rest of the organization, we had to make changes. On average, insurance reimbursement only covers 15–20% of the palliative care program costs. With rising costs across all service lines, it was simply not feasible to continue offering the comprehensive outpatient palliative program; instead, we looked for a way we could provide the essential components of the program. 

The restructured outpatient palliative care program, to begin at the end of May, focuses on a streamlined care navigator model that combines some aspects of hospice and palliative care. We have additionally reduced administrative roles across the division, in alignment with the above change. No changes were made to the inpatient palliative care program. 

These care model changes have not altered our commitment to supporting patients and families in our communities with complex, chronic, progressive, and life-limiting illness. We will continue to utilize our coordinated home health, home infusion, hospice and palliative services in partnership with PeaceHealth Medical Group providers, chronic care management services, outpatient clinics and hospital services.

The new model includes palliative care professionals to support high acuity patients. For example, specifically for our cancer patients, our palliative care physicians will continue to provide medical oversight during the transition period and will mentor one of our two oncology physician assistants to focus exclusively on the palliative care needs of this vulnerable population. Palliative care will continue to be delivered by a multi-disciplinary team with involvement of palliative care pharmacy, nursing, social work and spiritual care services.

We recognize that this decision may be met with anxiety; however, in light of extraordinary budget challenges, it was incumbent on us to look across the entire continuum of programs and services we offer and ask ourselves about each one: Is it sustainable? Unfortunately, the outpatient palliative care program is not.

— Contributed by Bryan Stewart

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