Health Calls Season 7, Episode 3 explores why palliative care is both a clinical necessity and a mission imperative for Catholic healthcare systems across the United States. Host Brian Reardon welcomes Dr. Mark Kantrow, System Medical Director for Palliative Care at Franciscan Missionaries of Our Lady Health System (FMOL), to discuss how palliative care improves outcomes for patients with serious illnesses while supporting families through some of life’s most difficult moments.
Health Calls Season 7, Episode 3 explores why palliative care is both a clinical necessity and a mission imperative for Catholic healthcare systems across the United States. Host Brian Reardon welcomes Dr. Mark Kantrow, System Medical Director for Palliative Care at Franciscan Missionaries of Our Lady Health System (FMOL), to discuss how palliative care improves outcomes for patients with serious illnesses while supporting families through some of life’s most difficult moments.
The conversation challenges common misconceptions that equate palliative care with hospice, emphasizing its role in whole-person care, symptom management, goal setting, and care coordination. Dr. Kantrow explains how interdisciplinary teams, including physicians, nurses, chaplains, and social workers, help align treatment plans with patient values while reducing unnecessary hospitalizations and readmissions. The episode highlights how investing in palliative care advances human dignity, improves patient experiences, strengthens quality outcomes, and reflects the core mission of Catholic healthcare.
Brian Reardon (00:05):
Greetings and welcome to Health Calls, the podcast of the Catholic Health Association of the United States. I'm your host, Brian Reardon, and with me is our executive producer, Josh Matejka. Hey, Josh.
Josh Matejka (00:13):
Hey, Brian.
Brian Reardon (00:15):
All right, we'll have another episode. We're talking under our theme of Health Reimagined. In this episode, we're going to talk about palliative care as a value driver, and we'll get into that with our guest in just a moment. But I think, Josh, the reason we chose this guest and this topic is because of a breakout session, a presentation that you got to sit in on at Assembly. Can you share a little bit about that?
Josh Matejka (00:38):
Yeah. And before I claim to have all the inside knowledge about that session, I'll be totally honest, I was working as room support at that session, so I unfortunately had to dip in and dip out at assembly as part of that. But I'll be upfront and say palliative care as someone who has been in Catholic healthcare for about five years is an area that I'm not as familiar with. And I personally am just, I am prone to all the typical cliches about what palliative care is and the role that it plays in the healthcare continuum. And so even sitting in on a little bit of that session, hearing Mark and some of his colleagues talk about the way that it can be a value driver for systems and talking about the important role it plays really challenged me and made me think about the upcoming podcast season that we were doing because I just think that as we look at palliative care, the importance that it plays, again, not just economically, but from a mission sense, like what Catholic healthcare is about in terms of human flourishing and whole person care, this is a huge value add for patients, for systems.
(01:49):
And I really want people to hear that. And so I was really excited whenever Mark agreed to be on the show because I think that what he and his colleagues presented on was really novel and I'm excited to hear him break that open for our listeners.
Brian Reardon (02:05):
Yeah, let's go ahead and bring in Dr. Mark Kantrow. He is system medical director for palliative care with the Franciscan Missionaries of Our Lady Health System, also known as FMOL. Mark, great to have you with us.
Mark Kantrow (02:17):
Thank you. It's nice to be here.
Brian Reardon (02:19):
Yeah, and I think Josh hit on a really important point. Again, I've been in Catholic healthcare for over 20 years. Both of my parents, I was with them at the end of their life as they were going through some major serious health issues. And it still amazes me that the knowledge and understanding of palliative care, even within Catholic healthcare, is pretty limited. And I guess maybe to start off with, and I hate to do this because we've talked about palliative care in other episodes over the seasons, but I think it's always a good place to start is, can you just share quickly the difference between palliative care and hospice care? Because I think a lot of times they get sort of bundled together.
Mark Kantrow (03:01):
They do, and for good reason, because in some ways hospice care is a result of the Medicare hospice benefit, which was developed by CMS. And it is end of life care for patients that are most likely in the last six months of life. It is a form of palliative care, but palliative care is much more than hospice care. So when people say, are they different? I usually say, well, they're not really different, but it's a broader spectrum really. So palliative care is much further upstream than hospice care is, much earlier than the last six months of life. And it is appropriate at any age, really for any patient who has a serious life-limiting illness. And we often get involved in the care of patients who are also receiving treatments. And so we work alongside their care team and take care of these patients really to provide the highest quality of care.
(04:06):
And it's a little bit different than hospice care too, because when you go to hospice, you're kind of thrown over the wall into hospice land and everybody else drops off a little bit. But palliative care is not like that at all. We work in different settings. We work in the hospital, certainly. We work at home in the care of patients. We have clinics, we're in skilled nursing facilities. We're all over the place. So more palliative care everywhere is kind of my mantra, but it's certainly much more than hospice care.
Brian Reardon (04:39):
And before we get into the discussion about some of your insights on the sort of value proposition of palliative care for Catholic healthcare, I do want to read a quote that you had said during your presentation at the assembly this past June. You said, "I think it's a great place for everybody to understand that for Catholic healthcare, palliative care is not a nice to have, it's a mission imperative." Why do you believe that?
Mark Kantrow (05:05):
Well, every Pope since John Paul II has given a shout out for palliative care. And I'll say that's the only subspecialty that the Popes really speak about. They don't say everyone should have cardiology, everyone should have this. But I think it speaks to the idea that it is care for the most vulnerable patients that we care for. And who are the most vulnerable patients really? They're the sickest patients. And I think the sickest patients are the ones that are most likely to receive care that is misaligned with their goals. And so I often liken it to falling into a swiftly flowing river where you get swept downstream when you become very sick and you go to the emergency room and then you go to the ICU. And often there are not opportunities to pause and understand who we're taking care of and what's important to them and what their values are, what kind of treatments they want and what kind of treatments they don't want.
(06:12):
So that is really the bread and butter of palliative care, getting involved in the care of those very ill patients and the care of their families to understand how we can take the very best care of them. And for the very first time now in the seventh edition of the Ethical and Religious Directives, palliative care has been specifically by name, it's been called out and it's been said that it is a requirement to provide the highest level of person-centric care to those that we're charged to serve. So there's always been a little bit of vagueness about that in the past related to the ethical and religious directives, but it's been spoken to specifically now. It's how we take care of people and it should be included in the care of every patient.
Brian Reardon (07:05):
Yeah. And I think before we get into the value add that it does, because I think that's really the reason we wanted to talk to you is to understand maybe the business side. I think the mission side is very clear and I'm glad you mentioned the poke shout outs and the ERD revisions. I think that's really important for those of us in Catholic healthcare. For a palliative care team though, when we talk about the cost involved, are there tiers, Mark, that you can do? So for example, if you had a palliative care specialist, a physician, and that's X amount of money and then the support staff of that, is that typically where the sort of business decision is made is we can't afford to recruit another palliative care physician or is palliative care something that could be done, I guess in sort of a tiered way where maybe you don't need a palliative care specialist or is it kind of an all in, all or nothing sort of proposition when we talk about true palliative care?
Mark Kantrow (07:57):
Yeah. Well, I think it depends on who you ask that question to. I'm definitely someone who thinks it is an all in care that we provide where we really take care of whole people, people who have spiritual needs, people who have psychosocial needs, people who have physical symptom management needs. And unless you've got team members who can address all those needs, one person can't do that. One doctor cannot do chaplain, social worker, doctor, nurse. So it takes a team. And so I'm certainly a proponent that we need everybody. However, it's costly. It's commitment to provide that. And so sometimes health systems, if they feel like their profit margin is not what they would like it to be, often they will cut right there and not hire all the team members that they need.
Brian Reardon (08:57):
Okay. Well, let's talk about why they should not do that. Why it's important to make that investment. And I think that was really the part of your presentation. We want to get your insights on this conversation is it is a must have. And we, again, know that the sort of wraparound whole person addressing the mind, body, spirit very much aligned with palliative care, particularly for somebody who's suffering a chronic condition that may have comorbidities and really needing that sort of coordination, if you will, to make sure all of their needs are met, not just their medical diagnosis and what kind of prescriptions they should be having or what procedure they may need in six months. Can you talk a little bit about, at a very high level, and then we'll probably drill down a little bit, what is the sort of return on investment for saying, you know what?
(09:42):
We are going to have a full palliative care team in this hospital. We're going to have a palliative care specialist lead the team. We know it costs money. There's not really a reimbursement model that maybe, like you said, provide the same return that hiring a cardiologist might, but what is the sort of business reason to do that?
Mark Kantrow (10:01):
Well, it's two-pronged really. If you don't provide an investment to hire enough staff members, you can't see the patients. And so there is something called penetration. What is the penetration of your palliative care team? And that is the number of consults you can see based on your annual admissions. And there's data surrounding that from the lowest quartile performing programs in the nation to the highest performing quartiles. And it's seven to 10% of the patients who are admitted to your hospital annually, you should be able to see. Those are the sickest patients where there is really a concentration of risk. It's a small subset of patients really with serious illness that drive not only the vast majority of poor quality outcomes for your institution, but are the most expensive to take care of. And unless you've got an expert palliative care team able to engage those patients and families, often you're not able to move the needle from a cost savings standpoint.
(11:11):
I mean, the question has been settled for 20 years about whether palliative care saves money. And it's been published in the Journal of the American Medical Association. It's been proven over and over again that getting a full team palliative care involved in the care of the sickest patients saves millions of dollars, millions and millions of dollars, and improves throughput, improves the patient and family experience of illness, which is a big metric these days that health systems are measured on and will be measured on in the future. And even can reduce 30-day readmissions because patients are taken care of and they are taken care of at the level of care that they want and they're offered options. Without palliative care, often that never happens.
Brian Reardon (12:07):
Right. And I can attest to that. Again, I referenced the care for my parents and my mother in particular, I can't even recall how many times she was readmitted time and time again because I think there was that lack of coordination. The left hand didn't know what the right hand was doing. She could have benefited greatly from palliative care. And even the hospitalist that was on staff at the time, I mentioned palliative care. It gets back to my original question. They said, "Oh, so you want to put your mom in hospice?" And it's just that lack of understanding of how it can benefit the patient I think is just sort of mind-boggling.
Mark Kantrow (12:44):
Yeah, what you want is you want another layer of care on top of what you're already getting to ensure that the medical care you're receiving is the very best and is what your mom wants and that everybody understands what's going on. Yeah.
Brian Reardon (12:57):
Yeah. And I think it would've prevented this sort of constant turnover ER visit after ER visit after inpatient stay, because a lot of what her care could have been provided at home in a more sort of holistic manner. So can you share a little bit about, and maybe you've already cited a few statistics, but what are some of the metrics that you would look at to say palliative care can reduce, like you said, readmissions, ER visits, more maybe intense level of care, length of stay, those type of things. Those all come into play as a benefit of providing holistic palliative care.
Mark Kantrow (13:33):
Oh, absolutely. And I think even for palliative care or hospice care that's provided at home, those patients often live longer, they do better, their experience is better. They don't go to the hospital as much. The cost of their care is reduced. It's really phenomenal how much money is really saved when palliative care is involved. In some studies for patients who either get palliative care or hospice, there's a $33,000 savings in the last year of their life, which is a huge amount of money. Those sickest patients are the ones that cost the most to take care of. Those are the ones that often the families are in crisis. Those are the ones that really need the most attention in the hospital. And often the very patients that the critical care teams, the hospitalist teams are least able to spend that amount of time with to ensure that they're providing the appropriate kind of care.
(14:34):
So there are other large palliative care groups, one's called Impassion Health, but in the final year of life, they showed data that revealed that 35% of the cost was reduced in taking care of these patients, 15% reduction in emergency room visits. I mean, these are all the things health systems really want to happen. But again, if you're not thinking about it in that very broad way, you're going to think about, well, how much is this service costing us? It's costing you a lot if you don't have it. It's costing you something, certainly in a dollar amount if you do have it, but how it serves the bottom line is really profound, I think.
Brian Reardon (15:21):
Well, and you just touched on something again, the theme of the season is health re-imagined. Do you think there may be a little bit of a lack of imagination in understanding the benefits and how do we get our leaders to think imaginatively about how palliative care can benefit not only the bottom line, but at the end of the day, the patients?
Mark Kantrow (15:41):
I think one thing I wanted to be sure to say in this podcast, because I think we get so focused on the numbers and how many dollars are we saving and whether you believe that or don't believe that, one of the most valuable things in my mind that has happened with our system level role is that we have developed an incredibly strong relationship with the system leads in quality, the quality people who look at how we're taking care of patients, whether it's the quality of medical care, whether it's the quality of the patient and family experience. And they are completely behind palliative care, understanding that if you have a strong hospitalist group providing excellent medical care and you have a strong critical care group providing excellent medical care and you have an ECMO team and you have all these different services, if palliative care isn't strong standing shoulder to shoulder with those teams, the quality of medical care that you provide is not going to be good.
(16:40):
It's what everybody wants too at the highest levels in the C-suite. They want the best quality medical care for the patients and families that they're taking care of, but it's impossible without palliative care, apart from the numbers, apart from reducing 30-day readmissions to the hospital and emergency room visits. So it's just common sense really that you have to have these teams, particularly in Catholic healthcare. Every one of our teams has a chaplain. And I'll tell you, after having practiced for 10 years without a chaplain as a community-based palliative care program, when we brought a chaplain in, it was transformative and has been transformative in how we take care of patients. I might ask a few questions about somebody's faith, but then I have somebody that can come in and really engage that family. And it moves the needle more often than you can imagine when we have a full complement, a social worker, a chaplain, we have a music therapist.
(17:43):
I mean, we have all kinds of people coming in to support this family. So everybody feels very well cared for and decisions are made that would not have been made because we're able to talk about things. We have communication skill training, we've got symptom management training. So the experience of patients and families when we get involved is so dramatically different than if we weren't there. And we hear every single day, I don't know what would've happened if you hadn't come to see our mom or helped us figure out what to do. And the experience might've been very different for your mom, Brian, had a strong palliative care team and reduced the burden of suffering that people experience, the vulnerability of being very sick in our modern culture. There's sort of an analogy I like to talk to, and you can stop me if I'm yammering on too much about when we're born, the analogy I love is we take off like planes.
(18:41):
We all know that a plane can't stay in the air forever, and we spend most of our lives at 30,000 feet going along and then something happens. There's a mechanical malfunction. We drop 10,000 feet and the cardiologist starts working on the engine, the neurologist starts working on this. And the goal is obvious and as it should be, it's to keep the plane in the air. And so you keep cruising along maybe at 20,000 feet, maybe at 10,000 feet, but over time you're going to continue to lose altitude. And what does modern medicine do? It tries to keep the plane in the air, which is great, but what about when you're a hundred feet over the ground and you're brushing the tops of the trees? What does modern medicine do? It tries to keep the plane in the air. And if it's a monocular focus on keeping the plane in the air, which it has been historically, it's obvious what's going to happen.
(19:33):
There's going to be a crash landing, which nobody wants, I'll tell you. But if you can take the patient, the person, and put them in the co-pilot seat, you can get the landing gear down, that really is what palliative care does. It tries to create an end of life experience that reduces suffering, which is the crash. And sometimes all you can do is spray foam on the runway, the plane's coming in, people for whatever reason, they can't get their head or their heart around what's happening, but you still take care of them. And so for me, that's the best analogy of palliative care and certainly where Catholic healthcare should be at the top of their game in taking care of these sick people.
Brian Reardon (20:19):
That's a wonderful analogy. And I think, yeah, we're all going to have to land the plane at some point, and I think we'd all prefer that it was a smooth landing and there's few bumps in the air on the way there. So a great analogy. No, this has really been enriching. I think you brought home a really important point that I was going to get, and I'm going to let Josh come into the conversation is at the end of the day, we can talk about money saved, but it's really about the patient experience and what it means for the patient.
Mark Kantrow (20:46):
Yes, absolutely.
Brian Reardon (20:48):
And that's what Catholic Healthcare. It's that sort of patient-centered, whole person care. And I think palliative care done right can really enhance that and put where the focus needs to be on that patient and the loved ones that are surrounding them.
Mark Kantrow (21:02):
Yes, yes. I get so tired of talking about money. I mean, we have to, obviously. We live and work and live within a profit-driven healthcare system in the United States, even in Catholic healthcare, but it's like shutting down your fire department because they're not turning a profit. That's what the palliative care team, it's like the fire department. When the house is on fire, I can tell you who they're calling. It's the palliative care team. And if you don't have a palliative care team to call, that's a problem. And if you don't have a palliative care team to call because you're saying that they're not making enough money or you can't afford it, that's your problem as a health system. And as a Catholic health system, it's indefensible.
Brian Reardon (21:43):
Oh, great points. Josh, I'm going to let you reflect. You've been listening in. Any final thoughts or questions?
Josh Matejka (21:50):
Yeah. And Brian, you actually kind of preempted my question before I got to it, because Mark, what I was going to ask about is something you mentioned earlier when you started talking about the bottom line, right? I mean, bottom line clearly has financial implications within it, and you talked about how palliative care can be beneficial to the bottom line, but so much of this conversation, especially toward the back end of it, has revolved around that patient experience and the family experience of the end of life. We tend to be so push that off, push that off. We need to avoid that as soon as possible. But like Brian said, and like you so eloquently termed, everybody has to land the plane at some point. And so how do we do that in a way that provides the most dignity to the person and value to the person at that period of their life because it still is a part of their life?
(22:39):
I'm wondering, as someone who has been practicing palliative care for so long, what kind of cultural shift needs to happen either in organizations. Let's focus on organizational cultural shifts that needs to happen so that the bottom line can move from, well, how much money are we saving to, but what kind of experience are our patients having with us?
Mark Kantrow (23:01):
Right, right. I think for Catholic health system, it's got to be a system level culture change because fish rots from the head, that's saying, and the opposite too. I mean, I think that if there's system level, top of the tier culture change, that filters down to every hospital, but you've got to have the support from the top. Culture change is one of the most beautiful things that I think we've seen over 20 years at our hospital where when I started palliative care, I would go into the lunchroom and doctors would come up to me and say, "Do not touch my patient." They didn't understand the value of palliative care. And so I spent a lot of time just talking about what is palliative care? What is palliative care? But over 20 years that we've been there with a strong team getting stronger and bigger, growing all the time throughout 20 years, we can chart how many more patients we're seeing year by year, by year, by year, by year.
(24:00):
Everyone develops a skill set in taking care of patients with a palliative care mindset. They might have what we call generalist palliative care skills. They can have basic good conversations about aligning with goals and patients' values and preferences, but everyone can do that. The intensivists can do it, the hospitalists can do it, which was definitely not the case 20 years ago. So now we certainly see the sickest of the sick. We see the specialty level palliative care patients, but also everyone's getting a light touch of palliative care in our institution. So it really is a culture change that's happened.
Brian Reardon (24:40):
Mark, thanks for your insights. I think I learned a lot. I tried to learn more and more about palliative care, but even in this conversation, I picked up some things. Appreciate you spending time with us for this podcast and for the presentation you did a few months ago to those attending the assembly. Really important topic. It's great that we've got a leader like yourself that's passionate about it, and we hope that those listening will pick up some things and be able to go to their leadership and say, "This is a must have." So again, thanks for your champion and your passion around palliative care.
Mark Kantrow (25:12):
Yeah, thanks for asking me. I'm a big fan of CHA. Yeah,
Brian Reardon (25:15):
We're a fan of yours. So again, that was Dr. Mark Kantrow. He's the system medical director for palliative care at FMOL, and I've been your host, Brian Reardon. Josh Matejka is our executive producer. Sarah Marchant serves as our scheduling producer, and Health Calls is produced here in St. Louis at One Studios. You can access all Health Calls podcasts at the CHA website, that's chausa.org/podcast. You can also listen and stream our episodes on all of your favorite podcast apps. And if you do so, we'd love to get feedback, give us a rating, give us some feedback. We'd love to hear from you. And as always, thanks for listening.