ARECENT SURVEY THAT GRADED THE 50 states on access to palliative care bumped the United States up a grade, to a B from a C in 2008. Despite the rapid growth of hospitalbased palliative care programs, the survey nonetheless reports ongoing barriers to access: too few trained professionals, knowledge gaps in symptom relief, and the need for new reimbursement models. The 2011 survey, carried out by the Center to Advance Palliative Care (CAPC) and the National Palliative Care Research Center (NPCRC) at the Mount Sinai School of Medicine, both in New York City, examined data taken primarily from the American Hospital Association Annual Survey Database for 2009. Of the 2489 hospitals with 50 or more beds surveyed, 63% had palliative care programs. Of hospitals with more than 300 beds, 85% had palliative care teams (http://www.capc.org /reportcard/). Seven states and the District of Columbia received an A grade, meaning that more than 80% of hospitals surveyed in those states reported having palliative care programs. Twenty-five states received B grades, indicating that 61% to 80% of hospitals had such programs. C’s went to 12 states where 42% to 60% of hospitals had programs; 4 states received D’s, with programs in 28% to 38% of hospitals; and F’s went to Delaware and Mississippi, each with 20% of hospitals surveyed having programs. States that made substantial gains since 2008 included Nevada, where the percentage increased from 23% to 69%; Mississippi, up from 10% to 20%; and Alabama, up from 16% to 28%. Hospitals with 300 or more beds were the most likely to have palliative care programs, while for-profit, public, and sole community provider hospitals were the least likely. Access to palliative care also varied widely among various regions of the country. For example, 73% of hospitals with 50 or more beds in the Northeast reported having programs, compared with 51% in the South. Lead author R. Sean Morrison, MD, director of the NPCRC, said that just as every hospital has an emergency department and intensive care units or beds, so should they have palliative care services for adults and children with serious illnesses. “I think that by 2020, we will be at a point where 100% of our 300-plusbed hospitals will have a palliative care team, and [more than] 80% of our smaller hospitals will have a palliative care [program],” said Morrison. He said data show that palliative care can cut hospital costs and improve the quality of care. In a study of Medicaid patients in 4 New York hospitals, Morrison and his colleagues showed that patients who received palliative care incurred $6900 less in a given admission than those who received usual care (Morrison RS et al. Health Aff [Millwood]. 2011;30[3]:454-463). If every New York hospital with 150 or more beds had properly trained teams that provided palliative services within routine patient care, the study estimated statewide Medicaid savings between $84 million and $252 million annually within 5 years. A study of 151 patients with metastatic non–small cell lung cancer, which usually has a prognosis of less than 1 year, showed that those who received palliative care had less depression and better scores on a quality-of-life scale than those who received usual care. Patients who were given palliative care early in their illness received less aggressive end-of-life care, but their median survival was 2.7 months longer than patients receiving usual care (Temel JS et al. N Engl J Med. 2010; 363[8]:733-742). According to the CAPC, an estimated 90 million Americans have serious or life-threatening illnesses. That number is expected to double in 25 years as baby boomers age. About 6 million people in the United States currently could benefit from receiving palliative care. Since 2000, the prevalence of palliative care teams in US hospitals with at least 50 beds has increased by 138%, according to the survey. That growth is among the factors that prompted the Joint Commission, which accredits about 4500 US hospitals, to launch a new cer-