Dr. Chad Farmer sees patients with very serious, even terminal conditions, such as cancer, emphysema and heart disease. Many ask this question when he walks through the door:
You're not from hospice, are you?
They ask because they aren't ready for hospice. They may equate it with death. They may not want to stop medical treatments meant to cure or prolong life, even if their suffering is intense.
Enter the palliative care movement - aimed at providing the comfort of hospice for people who aren't yet at the end of life.
The distinction is important both to patients and the physicians seeking to help them. And while it is touted as a less expensive way to provide better care, it also represents a new line of business for health care facilities.
Farmer is the medical director of Chapters Health Palliative Care. It's affiliated with LifePath Hospice, the major hospice provider in Hillsborough County.
Chapters Health Palliative Care started in 2006 for patients who need help managing their pain and other symptoms. Many of them are still getting curativetreatment such as chemotherapy and radiation, which hospice patients - defined by Medicare as people with six months or less to live - have usually abandoned.
Hospices around the country see a growing demand for palliative care, especially as baby boomers age and develop chronic illnesses that require comfort care.
Hospitals, too, are expanding their palliative care services, often in coordination with hospice institutions, since research findings show that it improves patient outcomes. It is thought that patients who are less stressed by pain are better able to stabilize or even improve their health.
The palliative care program at the region's largest hospital, Tampa General, served 1,300 patients last year. The hospital's foundation is about halfway toward its goal of raising $320,000 to convert some hospital rooms into palliative care suites.
At Suncoast Hospice, the dominant provider in Pinellas County, new chief executive officer Rafael Sciullo plans to expand the palliative care program, which last year served nearly 1,730 people.
Suncoast already has a home-based palliative care program and a consult service to two hospitals, Mease Countryside Hospital and Mease Dunedin Hospital, said Sciullo. He wants to expand the consults to more hospitals, and increase marketing for home-based care.
"We do want to dispel any myths that it's all about dying," said Sciullo. "Because it isn't."
Pasco-Hernando Hospice has an in-home palliative care program for patients who don't qualify for hospice. Gulfside Regional Hospice in New Port Richey started a spin-off company, Pasco Palliative Care LLC, which provides services to non-hospice patients at several facilities, including Morton Plant North Bay Hospital in New Port Richey and Medical Center of Trinity, said chief executive officer Linda Ward.
"It's really going to grow," said Ward. "Many hospitals have come on board to recognize that palliative care helps prevent readmissions."
That's important at a time when the Medicare program is penalizing hospitals whose patients are readmitted too soon.
Palliative care could also provide new Medicare income to hospices, who stand to lose money if the federal government clamps down on who qualifies for Medicare's hospice benefit.
Why is Medicare eyeing hospice payments? Because most of Medicare spending on hospice in 2011 - $13.8 billion - was for patients who lived longer than six months, the trigger for the hospice benefit. While it's often not possible to predict when a person will die, that large imbalance, critics say, indicates that some hospices are admitting people who should not qualify for the Medicare hospice benefit.
As a physician, Farmer says he sees every day how palliative care improves the lives of patients who face not only major illness, but also complicated treatment plans that can be difficult to navigate outside of the hospital. In fact, he said, LifePath's parent company began its palliative program as a consult service at St. Joseph's Hospital and Florida Hospital, both in Tampa. Patients were leaving the hospital and going on to live for years at home but without a coordinated plan to address their symptoms, he said.
Pain is just one issue. An emphysema patient, for instance, might also need low doses of morphine to help him deal with severe shortness of breath. The palliative team helps patients prepare advanced directives explaining what kind of health care they want as they reach the end of their lives.
"What you find is a lot of these doctors know that (their patients) needed this type of care, but they just didn't have the time," said Farmer.
Denise Alessandro is the sole caregiver for her 86-year-old mother, who has dementia, advanced arthritis and other ailments.
"We didn't feel Mom was quite ready at that point for hospice, but we wanted some direction," the Apollo Beach woman said. Farmer helped them with some small changes that made a huge difference, from getting them a hospital bed and wheelchair, to connecting Alessandro with caregiver support groups.
In recent weeks, Alessandro's mother began qualifying for hospice care. As is the case in many families, the time in palliative care is making that transition easier to accept.
"I think it's a wonderful program," Alessandro said of palliative care. "I wish more people knew about it."
Jodie Tillman can be reached at firstname.lastname@example.org or (813) 226-3374.