Taking Healthcare by Storm: Industry Insights with Dr. Erik Soiferman

In this captivating episode of Taking Healthcare by Storm, delve into the world of expert insights as Quality Insights Medical Director Dr. Jean Storm engages in a thought-provoking and informative discussion with Erik Soiferman, DO, MBA, FACOI, FACP, founder and owner of Bridges Palliative Care. 

If you have any topics or guests you'd like to see on future episodes, reach out to us on our website. 

This material was prepared by Quality Insights, a Quality Innovation Network-Quality Improvement Organization under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services (HHS). Views expressed in this material do not necessarily reflect the official views or policy of CMS or HHS, and any reference to a specific product or entity herein does not constitute endorsement of that product or entity by CMS or HHS. Publication number 12SOW-QI-GEN-083024-GK

Transcript

Welcome to Taking Healthcare by Storm, Industry Insights.

The podcast that delves into the captivating intersection of innovation, science, compassion, and care.

In each episode, Quality Insights Medical Director, Dr.

Jean Storm, will have the privilege of engaging with leading experts across diverse fields, including dieticians, pharmacists, and brave patients navigating their own healthcare journeys.

Our mission is to bring you the best healthcare insights, drawing from the expertise of professionals across West Virginia, Pennsylvania, and the nation.

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Hello, everyone, and welcome to Taking Healthcare by Storm.

I am Dr.

Jean Storm, the Medical Director at Quality Insights, and I am so excited to be talking to our guests today.

We're talking about a topic that is very close to me, very near and dear to my heart with my work in long-term care and working with individuals who have complex medical conditions and nursing home residents.

We're going to be talking about palliative care today, and we're talking with Dr.

Erik Soiferman, who is the founder of a practice group called Bridges Palliative Care.

And we're going to be talking about the importance of palliative care and how it can benefit many, many patients, residents in nursing homes, and how there's a lot of misconceptions around palliative care.

So hopefully, we're going to be providing a light to palliative care and explaining it more today.

So Erik, thank you so much for joining us today.

Absolutely.

My pleasure.

So tell us, first off, how did you come to do what you do?

It's a bit of a roundabout story.

When I finished my residency in internal medicine, I worked in the emergency departments.

And you go from save everybody.

And when I left the ER, I had no idea what palliative care was.

And I joined a general internal medicine practice.

And I was introduced to the idea of hospice and palliative care and was very intrigued because when it all boils down to it, you know, you can't save everybody and everybody faces their own mortality.

So I investigated a little bit and wound up finding that that's something that I really was interested in, really believed in.

And I got board certified and sort of took it from there and trying to spread the word and grow the information and grow the understanding of palliative care across the care spectrum.

I think that's really important across the care spectrum.

Very important.

So just maybe I know this is going to be difficult to put into a short answer, but can you tell us what palliative care is?

And I hate to maybe compare it to hospice, but that might be necessary.

But let's just start with, so what is palliative care?

So palliative care is the medical specialty of chronic disease management, chronic symptom management.

But I think it's important what you said, because everybody does link palliative care and hospice together.

And I had a professor in college for chemistry, walked up to the board and said, at that time we had blackboards.

And he just wrote down, mass ain't weight.

And it's kind of the same thing, palliative care ain't hospice.

I think it's really important to think about palliative care as its own medical specialty, just like cardiology, just like gastroenterology, nephrology, internal medicine, family medicine.

We provide a specialized service for patients that encompasses more than any one specialty would do, including these days, the primary care, simply because primary care typically just doesn't have the time to do everything that is required for palliative care.

That's a great answer.

And I think a lot of people think about, I know I used to think about palliative care, that it was like a bridge to hospice.

Like you're kind of in the, I'm gonna do everything and anything, CPR, put me on the ventilator.

And then maybe you go down the line and say, okay, I'm gonna become palliative care.

And then eventually you become hospice care.

So can somebody just have palliative care services and then not do hospice services?

Absolutely.

They are, that is the message that I'm really trying to find a way to get out there.

They are separate and distinct, whereas hospice focuses on end of life care, non-treatment, quality of life.

Palliative care focuses on quality and quantity.

You have to qualify for hospice.

You have to be certified that you have a hospice diagnosis.

You have to have a prognosis of less than six months.

A physician has to sign off on that.

You have to continue to be recertified if you don't decline.

Palliative care has none of those requirements.

Palliative care is, you know, anybody typically that has, you know, used to be three or more chronic medical conditions.

Now it's really any medical condition that requires extra care can see a palliative care specialist.

That's excellent.

I think that's really important that, you know, and maybe we do need to separate a little bit palliative from hospice to really...

Yes, it's important.

So do you think that there's been a greater need for palliative care since the pandemic?

That's a tricky question.

Do I think there's a greater need?

I don't, but I think the need was there pre-pandemic as well.

I think that we are a little bit more in tune to what diseases are out there, what chronic conditions are out there.

I think that COVID through the entire world, but certainly the medical world, into a very new era where our eyes are wide open.

And we have people suffering from the consequences of COVID, which is kind of making us think that, well, there's more people that need palliative care.

I don't think that's the case.

I think it was always there.

I just think we might be a little more aware of the availability of palliative care post-pandemic.

Yeah, I would agree.

So, let's talk about the benefits.

We were talking a little bit before the podcast about how I think some people probably aren't aware, but depending on when you sign on to palliative care services, it actually improves quality of life, improves length of life.

So, what are some of the benefits that someone can obtain from palliative care services?

Well, you wanted to keep this under half an hour or so.

So, I'll keep it all going and on.

I can't tout it enough from the benefits.

Not only do you get another medical provider taking a look at everything.

One of the biggest issues we have these days, even with the EMRs, as you know, is the continuity of care across the spectrum from the hospital, to the nursing home, to the skilled, to the assisted living, to the community.

There's a drop every time you use transition.

There's even a drop between a specialist talking to a primary care.

Do those records get sent over?

The palliative care providers can function as the conduit.

You get not only the medical care, but we have our pillars of palliative care, whereas we look at psychosocial issues, we look at the family dynamics, we look at spiritual dynamics, we look at financial dynamics, we talk about goals of care, we talk about end of life when necessary.

We recognize that when it is time to talk about hospice, it's been clearly demonstrated that early hospice leads to better satisfaction for everyone.

And we could get into the studies and all of that that show that 98 percent of patients, I believe, once they've had palliative care, when you ask them, would they have done it earlier if they had known about it, it's an overwhelming yes.

Early palliative care has been shown to increase quality and quantity of life in lung cancer patients.

You know, when they're asked to be involved earlier, there's just so many benefits.

There's virtually no downside to involving palliative care.

Yeah, I would most definitely agree.

So, you know, when we're talking about benefits, so what type of diagnoses are appropriate for palliative care?

Well, again, we could turn to Harrison's textbook on medicine and just start at A and go down to Z.

But really, we're looking at the most common ones that we see would be the most common things that are on everybody's radar.

Congestive heart failure, COPD, cancer, alzheimer's.

But really, it's anybody that has chronic conditions that are going to require a little bit more of oversight.

Chronic kidney disease.

The difference, you know, if you have chronic kidney disease, if you're on dialysis, you won't qualify for hospice, but you would be able to see a palliative care provider.

Because we would be able to say, for example, you know, what do you do when you can't get dialysis anymore?

When someone is diagnosed with Alzheimer's, that's the time to get palliative care in place, because that's when you want to talk about the, you know, the idea of what do we do when they need a feeding tube and why that wouldn't be the best idea medically.

And so when the families have to make these decisions and the patients have to make these decisions, they've had these conversations beforehand.

Those are the biggies, but really it's any chronic condition that we think might eventually decline, or anybody that needs, you know, a little bit extra help, a little bit extra guidance.

That's all appropriate for palliative care.

I think that is one of the biggest strengths of palliative care is that conversation.

I don't know how many times I hear about, you know, nursing home residents or anyone with complex chronic disease for that matter who gets sent to the hospital because, you know, it's just the emergency, you know, it's urgent and they, you know, need maybe to have a BiPAP applied to help them breathe or maybe they get, you know, say, oh, you know, you need to go on the ventilator and they say, I don't want this, you know, and so you didn't need to go to that trip to the ER and do all of that.

Like if someone had had kind of had the conversation beforehand, you know, it's huge.

And so, you know, leading in to that, talking about goals of care, discussions and advanced care planning, I know obviously all primary care physicians are kind of busy and, you know, not able to spend the time that probably they need to be spending, you know, and having this conversation.

So, you know, can you talk a little bit about the importance of having goals of care conversations and advanced care planning discussions?

Sure.

Well, I mean, part of it is exactly what you said, and we can look at this from multiple different angles.

You know, part of what I've done in the past as physician advisor to the hospitals, I've worked on the insurance company side as well as the provider side to look at utilization.

And we can look at it from a financial standpoint of, you know, are we spending the health care dollars where they need to be spent?

But if we look at it mostly from a patient care standpoint, it's exactly right.

The goals of care discussions have typically fallen to the primary cares, but they just don't have the time anymore.

And sometimes they really don't have the desire.

And, you know, sometimes it's even that discussion is started, but there's pushback or there's hesitancy.

And sometimes having palliative care involved to bring a different perspective and a different way of bringing it up can be very helpful.

You know, I think that one of the things we have to realize is that there are all kinds of family dynamics.

There are all kinds of psychosocial dynamics.

There are all kinds of cultural dynamics.

And palliative care is specifically trained to be able to navigate those.

It's really important these days to ask the patient what they want.

You know, going back for the question about since the pandemic, I think one of the things that we kind of have seen is, when families weren't able to visit each other, there has become more of a involvement with families in their parents or siblings or individuals' health care.

And they start to say, well, they might want this, they would want this.

And nobody bothers to really ask the patient and say, well, what is it that you want?

And palliative care is specially trained to address that, to sort of bridge those gaps, no pun intended, and really get to the bottom of, what is it that you want?

Do you want to go to the hospital?

Do you want to be put on a ventilator?

And a lot of times the patients, you know, we hear often, a lot of times the patients say, well, I don't really want to, but my family wants me to.

And that's something that we have to really be able to drill down to and do the right thing for the patient.

And really provide the right care in the right place at the right time.

And that's a long-winded answer, but it's really important.

Yeah, I 100% agree.

The right place, the right time, the right care, yes.

So I got very excited when I took a look at your website for Bridges Palliative Care.

So tell us about the model that's used in your practice.

So Bridges was set up.

The way it started was I was medical director in a nursing home and we had a lot of unplanned transfers to the emergency department, and we tried to figure out ways to do it.

And I said, well, we need to put a nurse practitioner on the floors.

And they said, well, we don't have one.

And I said, well, I can find one.

So I did and I put a nurse practitioner in the building, and was able to start this process of pulsed forms.

And the social workers in the facility are so overwhelmed that they don't have time to do it in a lot of places.

The nurse practitioners were able to recognize decline, recognize changes in status and intervene quickly and slow down and decrease those hospitalizations.

And from that, we kind of said, okay, well, what else can we do?

And we recognized the gap in the patients coming back from the hospital where maybe they saw palliative care in the hospital, but there's no communication or follow up from the outside.

And so it's essentially starting over.

And we hooked up with a lot of home care agencies.

We hooked up with inpatient palliative care companies.

We've hooked up with a lot of hospice companies.

And we try to be the conduit between all of those care organizations so that there's no drop and that communication continues.

And we're able to say, you know, we've talked to this provider that you know, and this is what we know you talked about.

What do you think?

And continue that along.

And so Bridges has grown into providing palliative care across the spectrum in nursing homes, personal care homes.

And we also do community based, mostly via telemedicine, which is its own animal.

But we really try to reach as many people as we can.

We try to cut down on transfers back to the emergency room when someone leaves a skilled facility.

And again, really trying to make sure that nothing gets lost in transitions of care and really be the go-to for the continuity.

I feel like that's so important, like being at the center with the patient and really owning the care of that patient, because that is so needed right now.

I mean, it's so much falls into the cracks.

So you talked about individuals living in the community at home.

So what kind of services does palliative care offer to individuals living at home?

So the beauty of palliative care is that it travels.

We can do everything from physician or nurse practitioner visits, we can have social work visits, we can help arrange for home care, we can help arrange for spiritual guidance, we can help arrange for financial.

Palliative care is not limited to an office.

Much of palliative care is designed to support the medical aspect and not be the medical aspect.

So anything can really be done at the home.

One of the things that's really cool about what we do is, we don't have our own home care, we don't have our own hospice, we work with home cares and hospice.

So that staying independent, we're able to work with those companies and not interfere financially, but also collaborate with them to provide the care that they can provide in the home, wound care, DME, et cetera, et cetera, and allow patients more access to care while staying at home.

And I think it's maybe a strength to be, you're on your own and not kind of part of a company that also offers hospice, because I think that makes a lot of individuals kind of reluctant, you know, unfortunately, to sign on to palliative care.

If it's like, you know, such and such hospice and palliative care, you know, people are, I think, a little bit more reluctant so they don't have the benefit of palliative care.

And then you collaborate with hospice if needed.

So it's really, I think it's really great.

Exactly.

And I've worked very hard to remain independent.

I've been asked to be hospice medical director, and I've said no, because I don't want there to be any kind of bias or any kind of thought that, well, they're just going to, you know, even though you're by yourself, you're just going to send off to this hospice or that hospice.

We certainly, you know, I'm a huge believer in hospice and I'm a huge believer in early hospice.

But only when you're ready for it, and only when the discussions have been had, and you know, only when it's appropriate.

I don't want to have any pressure from anybody to, you know, how many people have you put on hospice today?

Because, you know, hospice is a business just like anything else when it all boils down to it.

And we want to make sure again, we're doing the right thing for the right people at the right place at the right time.

Yeah.

So we talked about palliative care in the home.

So how does that, how does palliative care look different for an individual who's in a nursing home?

It really doesn't.

There's pros and cons to the nursing home.

The upside to the nursing home is that you know where the residents are going to be, you know where they live, you know they're going to be there.

And so you're able to see them.

One of the difficulties we face in home visits is, it is difficult to be a private practice and have people going from home to home.

So we do rely on telemedicine as a mainstay of our practice.

In the nursing homes, we're able to put somebody in the facility.

We're able to coordinate with the social worker that's there.

We're able to coordinate with the primary that's there.

We're able to read the chart.

We're able to look at all of that stuff that's centralized.

The downside to it is, again, you know, it is the misunderstanding of what palliative care is.

And we still get some pushback from facilities and from providers that don't want palliative care to see their patients because they're not ready for hospice.

And so we have to do the education.

It's a little easier to provide it in nursing homes than it is at the home, but it's just as important.

Yeah, that's what I was gonna ask about the pushback.

Do you have resistance in the facilities themselves, like among the staff to go in and provide palliative care services for residents?

I think it starts at the top.

And what we try to do is to get the buy-in from the administration, the directors of nursing, social work.

We really try to involve the team and then we really have to educate the floor nurses and the nursing supervisors on what services we provide.

The pushback we get from most of the time from the staff is that they're just so busy that they don't have the time to do anything else.

And so we try to tell them, well, you're not going to do anything else and we're actually here to help.

We still get pushback from providers regarding visits and not understanding that palliative care, we can see patients at the same time on the same day and providing different services.

We get pushback for, again, the biggest pushback we get is that, well, what do I need you for?

They're not ready for hospice.

We're really trying hard to break down that barrier.

Yeah, I think that's so important.

And I think once you get, once palliative care is in the facility, I think there's total buy-in.

That's what I have seen.

Once we can show the benefits, it's, oh my goodness, where have you been?

The hardest part that we find is trying to impress upon them.

We were talking about it beforehand is, when we go in and someone says, well, how many people do you think would qualify for palliative care?

My typical answer is, well, how many beds do you have?

Because that's how sort of, I guess deep the misunderstanding goes of what palliative care is and what it can provide.

Because by the time you're in a skilled facility or even a personal care home, you have something wrong with you that you can't be independent on your own, at least temporarily.

That's a great palliative care console.

Let's make sure that we do everything we can to get you back to your baseline as best we can and make sure that doesn't happen again.

And I typically say that the best palliative care consult that we could get is where we go in and we see there's a pulse form filled out, there's an advanced directive filled out, the medications have been reconciled, everybody understands their disease process, and there is absolutely nothing for us to do.

That's fantastic.

So rare.

And that's what we're trying to do.

We're trying to make it so that when the primary comes in, all of that stuff is done for the primary.

Yeah.

So very important.

So is palliative care covered by insurance?

It's covered by most insurances.

Most insurance will recognize it.

There are certain insurances that will not credential private palliative care companies because they either have arrangements to do it themselves or they're soup to nuts coverage.

But Medicare, Medicaid's and most of the private insurances will cover palliative care.

One of the things that's really important to understand is that palliative care is a specialty for Medicare bills under part B, whereas all of the other services, nursing home, hospice, skilled wound care, skilled home care, etc, bill under part A.

For example, if you're on hospice, you can't also have home care.

If you're on hospice, you can't also have physical therapy for the most part.

You can get a physical therapy evaluation.

Don't want to get into the weeds on that one.

But you typically would have to, if you're in a skilled facility, for example, you can't get the skilled care coverage or the nursing home covered and the hospice covered.

Medicare won't pay for both.

With palliative care, we bill separately.

You do not have to give up your skilled care.

You don't have to give up your home care.

You don't have to give up your PT or OT, your speech, your wound care, your whatever.

And that's really important when we're talking about insurance is, you don't have to give anything up.

The flip side to that is people need to understand that we bill, palliative care bills just like their primary does, just like a specialist does.

So there might be a deductible included.

There might be a co-pay involved.

And all of that should be explained to patients and caregivers upfront.

Yeah, absolutely.

So how does someone sign up for palliative care?

So it's really as simple as, you know, for Bridges, for example, we have go on our website and we have a, you know, request information.

Most places have the same thing.

You can ask your doctor, you know, how I'd like to get involved with palliative care.

I'd like to see a palliative care provider.

Most of the hospitals have a palliative care service.

It's a lot easier than you think to find a palliative care provider.

Most people just don't think or know to look for one.

And hopefully, you know, doing things like this podcast will help to really change that.

Hopefully.

So last question, I asked almost every guest, if you were in charge of the healthcare in the United States, what is the first thing you would do?

Yeah.

When I read this question, I kind of laughed because I don't know.

I think that getting involved in a discussion, a political discussion of Medicare for all is not the way to do it.

I wouldn't start nationally personally, I would start locally.

I think that from again, being on this, on having experience on both sides of inpatient hospital work, being as a provider and also being on the insurance and looking at what is being approved and what is being denied.

I think that the insurance companies really need to be put into check.

There's really no real, I'm not sure even what the word is.

I don't want to say oversight, but for example, for the amount of money that I have to pay for my personal insurance plus a deductible, I should be able to get pretty much whatever test my qualified physician feels is medically necessary.

Yeah.

And the pushback from the insurance companies and the denial of services from the insurance companies based on almost nothing is really discouraging.

And I've been in a situation where you have to jump through so many hoops just to get something approved that is just absolutely the standard of care.

And that's where I would start is having some type of oversight or some type of change to the way that the insurance companies are able to approve or deny pretty much whatever they want to approve or deny and really change access to care for people.

Because by doing that, the upfront spend might be a little higher, but the back end spend is going to be so much less.

And paying for and encouraging something like palliative care is going to save millions and millions of dollars on the back end by saving emergency room visits and hospitalizations and surgeries and amputations.

And it's going to save so many healthcare dollars that are going to then be able to go to people that really need those healthcare dollars.

So that's where I would start, is locally rather than nationally.

I would build up rather than trickle down.

I love that.

That's a great answer.

So if people want to learn about Bridges, where can they go?

Can you tell us what your website is?

Sure.

It's really easy.

It's bridges palliativecare.com.

And we will link that in the podcast.

So Dr.

Erik Soiferman, thank you so much for joining us today.

It was a great conversation.

I really enjoyed it.

Me too.

And I'm happy to be here and really appreciate the work that you're doing to advance palliative care.

Excellent.

Thank you.

Bye-bye.

Thank you for tuning in to Taking Healthcare by Storm, Industry Insights, with Quality Insights Medical Director Dr.

Jean Storm.

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