Getting from More to Enough: Leveraging Research, Policy, and Clinical Excellence to Grow Palliative Care

ince palliative care was founded, the overarching goal has been "More".Access to palliative care in more hospitals.Access to palliative care in more care settings, in community clinics, longterm care residences, and private homes where patients and families need it across the course of an illness.More frequent touchpoints with palliative care teams.More access for historically underserved or oppressed patient populations who need and deserve a patient-centered approach to care.More access for children outside of hospitals and in their communities.More time spent receiving the benefits of palliative care, earlier in the course of an illness.And indeed, when we look across the United States today, our patients have more access to palliative care than ever before.The percentage of hospitals with 50+ beds that offer palliative care has more than tripled since the early days of 2000 and now stands at over 80%. 1 Multiple studies published in this journal have demonstrated the positive outcomes associated with earlier palliative care consults, 2,3 including Dr. Wang and colleagues' finding in this issue that earlier palliative care consults are associated with higher-quality endof-life experiences.Health plans now contract with palliative care teams to provide access to their members.In California, Medicaid beneficiaries have legislatively mandated access to community-based palliative care.And yet, none of us believes that our patients in need have access to "enough" palliative care.We know that in rural areas of the country, in for-profit hospitals, in the homes of patients who don't live in the right zip code or aren't "sick enough," palliative care is not reliably available for patients and families who need and deserve it.And, as Dr. Sy and her colleagues point out in their Palliative Care Review, we are still very much in the process of developing evidence-based practices for tailoring our services to provide equitable care for ethnic and racial minorities.How do we get more palliative care where and how it's needed?The answer is simple: this is a payment issue.We