Patients with complex illnesses, multiple chronic conditions, and functional impairments make up only 5 to 10 percent of patients; yet they account for two-thirds of the nation's health care costs. Despite these enormous expenditures, these patients and their families report untreated symptoms, unmet needs, high caregiver burden and low satisfaction.

To improve quality of care for patients with life-threatening and chronic illness, hospitals increasingly are establishing palliative care programs. Annual survey data show that hospital palliative care programs have increased rapidly in the last decade, with more than a third of community hospitals offering these services in 2009. As health care delivery becomes more focused on the care continuum and effective and efficient patient-centered care, palliative care is poised to play a critical role.

Emerging models—such as accountable care organizations, patient-centered medical homes, and bundled payments for a care episode—that stress improving quality for high-need patient populations while at the same time controlling costs make palliative care an even more important hospital service. By focusing on patient-centered and goal-driven care coordination and identifying and treating problems before crises prompt preventable emergency department visits or hospitalizations, palliative care and, when appropriate, hospice programs improve quality and length of life in high-risk patient populations, and reduce unnecessary spending.

With the goal of decreasing symptom burden and improving communication about prognosis and patient goals, dedicated palliative care teams help patients achieve their best possible quality of life while reducing costs and family burden and improving family satisfaction. Contrary to some expectations, studies demonstrate palliative care significantly prolongs life among selected patient populations.

The team's expertise leads to better decision-making by the patient and family, clearer care plans, and consistent follow through. Palliative care strives to ensure the right care is given in the right place at the right time, reducing preventable readmissions and emergency department visits. With better family support, care coordination, and home care and hospice referrals, patients stay out of high-cost ICU beds and benefit from supportive settings, avoiding the costs and the burden of nonbeneficial imaging, laboratory, specialty consultation, and procedures.

The rapid growth of hospital palliative care programs in the last decade has positioned hospitals and health professionals to respond to the unmet needs of a seriously and chronically ill patient population with significant care needs. Hospitals with strong palliative care programs linked to implementation of these new delivery models are well-positioned to achieve the quality and health care value objectives at the heart of American health reform.

For more information about hospital palliative care, see The Center to Advance Palliative Care was awarded the American Hospital Association 2009 Award of Honor "for an exemplary contribution to the health and well-being of the people through leadership on a major health policy or social initiative."

Diane E. Meier, M.D., is director, Center to Advance Palliative Care; director, Hertzberg Palliative Care Institute and professor, geriatrics and internal medicine, Mount Sinai School of Medicine. You can contact her at

Rich Umbdenstock is president and CEO of the AHA. You can reach him at