Graduate Student Profile: Tyler Towers
From Hospice to Hospital
A Naval officer works toward a Ph.D. degree in health policy and administration with a goal of improving care for patients.
When Tyler Towers was a master's student at the University of Memphis, the Salt Lake City native spent much of his free time working as an intern at a local home health and hospice agency.
"I accompanied hospice nurses on home visits and was able to see firsthand the impact that hospice programs can have on terminally ill patients and their families," said Towers, a commissioned officer in the United States Navy (Medical Service Corps) who is on active duty with orders to earn a Ph.D. degree in health policy and administration. "It opened my eyes to the wonderful things that hospice can accomplish."
A graduate student in the Department of Health Policy and Administration at Penn State, Towers has conducted research on hospice care for which he recently won the Student Research Paper of the Year Award from the American Academy of Medical Administrators for his paper “Optimizing Value for Medicare Expenditures at the End of Life.” Towers received the award at the academy's 2012 annual conference held from November 13 to 16 in San Antonio, Texas.
The paper is an argument for more extensive use of hospice services in place of aggressive, curative treatment for terminally ill patients, which is often the default choice at the end of life. To make the argument, Towers examined several potential access barriers to hospice and offered strategies that the Medicare program might consider to overcome these barriers and increase hospice utilization among its enrollees.
"End-of-life care represents a disproportionate share of total Medicare expenditures, with approximately thirty percent going to support the approximately five percent of enrollees who die each year," said Towers. "In some cases, physicians and family members choose to pursue aggressive curative treatment in an attempt to prolong life even when death is inevitable. For the patient, this often means dying in a hospital bed in pain and discomfort when he or she may prefer to die more peacefully at home or elsewhere. In an era of booming health care costs and tightening budgets, it is critical that the Medicare program obtain optimal value for every dollar spent on end-of-life care.
"I personally believe that hospice would be a better alternative for many patients, even if it weren't the more economical choice," said Towers. "That said, it is a lower cost alternative—and, likely, the more desirable choice—for a good portion of Medicare enrollees. This is the main premise of the paper—that our system continues to funnel patients toward a more costly and less desirable end state. If the Medicare program were to explore some of the barriers to hospice utilization that I mention in the paper, it may be able to achieve a more economical outcome for many of its enrollees."
While Towers continues to be interested in the topic of hospice care, he has moved into another line of research for his dissertation. According to him, hospitals in the United States submit to accreditation inspections every three years or so, but because hospital personnel tend to fixate on re-accreditation as the ultimate goal of these inspections, few pay attention to the potential side effects of the inspection process, particularly at the level of the patient or hospital employee.
Towers is creating a conceptual framework for why certain side effects might occur. Specifically, he proposes that patient outcomes, such as inpatient death and preventable readmission, may actually improve as hospitals become re-accredited, but that any improvements likely fade away fairly quickly. Additionally, he proposes that hospital personnel may be more likely to reassess their perceptions of their hospitals during accreditation cycles but that, like patient outcomes, any changes are likely to fade as hospital operations return to normal following the inspection.
As part of the conceptual framework, Towers also is examining monthly risk-adjusted mortality rates in 58 New Jersey hospitals over a ten-year period. The study specifically compares risk-adjusted mortality rates in close temporal proximity to accreditation inspections to rates at other times and finds that rates do actually improve temporarily.
Finally, Towers is investigating individual perceptions of organizational legitimacy in 23 United States Navy hospitals over a three-year period. This study compares observations of perceived legitimacy during accreditation cycles to observations obtained at other times. Towers observed that accreditation inspections did in fact trigger reassessment of legitimacy, but such reassessments did not last beyond a few weeks after the inspection.
Towers said he chose to attend graduate school at Penn State because the Department of Health Policy and Administration was well regarded in the greater community and had a strong track record for educating military officers. "I have not been disappointed," he said. "The faculty is fantastic and I have really had a great experience here."
In November, he learned that he will be reporting for duty as a researcher at the Center for Naval Analyses—a Navy-sponsored think tank with a subsection dedicated to health services research in Alexandria, Virginia—upon completion of his studies. After that, he hopes to assume a faculty teaching position in the U.S. Army-Baylor Master of Health Administration program.