Hospitals Increasingly Offering Home-Based Palliative Care

At a time when more health care stakeholders are recognizing the value of home-based care, a rising number of hospitals and health systems are expanding their services into the community, particularly when it comes to palliative care. 

Home-based palliative care could reduce societal health care costs by $103 billion nationwide within two decades, according to the nonprofit economic research group Florida TaxWatch.

Palliative care in general can reduce health care costs by more than $4,000 per patient, according to a July 2017 study in Health Affairs. It can also reduce the frequency of 911 calls, emergency department visits, and unnecessary hospitalizations.

Nearly 80% of consumers who received background information on palliative care said they would choose it for themselves or their loved ones, according to a recent survey by the Center to Advance Palliative Care (CAPC).

“The reason that palliative care has grown so rapidly during the past 15 years is both because of the evidence of markedly improved quality of care for the most complex, high-need patients but also because hospitals are reimbursed on a lump-sum basis,” Diane Meier, executive director of CAPC told Hospice News. “Hospitals are paid a single sum of money for the entire hospital stay, so if the hospital stay is short and sweet the hospital has some hope of a margin on that reimbursement. For the complex patient who has unmanaged pain or shortness of breath, the stay can become longer than the reimbursement amount.”

North Dakota-based CHI-St. Alexius Health System has extended its palliative care program to include outpatient and home-based services. The hospital’s inpatient palliative care team in 2013 became distinguished from its hospice services. The program took off after the hospital began participating in the American College of Surgeons’ Commission on Cancer program, as well as achieving certifications such as trauma care, for which palliative care was a benchmark.

“For years the hospice team would talk about how they wished they could help a patient who was not yet terminal. Many patients could benefit from palliative care, but at the time we had no way to serve them,” Laura Archuleta, MD, the program’s medical director, told Hospice News. “Now that we are expanding into the home, it was again about seeing where the need really lies. The inpatient program was a great start, but patients were being discharged just as we were getting to know them. We knew we needed ambulatory and home-based options to continue the work.”

St. Alexius is not alone. Athens, Ga.-headquartered St. Mary’s Health System is expanding their hospital-based palliative care program outside of their walls and into patients’ homes in three Georgia counties. SSM Health and Allina Healthhave made similar announcements.

St. Louis, Mo.-based SSM Health is a health system operating in Missouri, Wisconsin, Oklahoma and Illinois, that offers hospice and home health care through its SSM Health at Home division. While the system expects its hospice operations to grow in coming years, home palliative care is expected to see the biggest growth area for for home-based division going forward.

“Palliative care is that gap care that’s in between home health and hospice for chronic care patients,” Robert Pritts, president of SSM Health at Home, said. “We do a lot [of] work with hospice and home health, and we’re starting to get into what they consider to be transitional care, which is nurse practitioners that are actually able to look at what’s going on in the home. We literally hired a chief medical officer for palliative care in Wisconsin, who [is helping to] develop the whole entire gap program.”

SSM Health is testing a home-based palliative gap care program in its Wisconsin market through Dean Health Plan, a member of SSM Health, and its value-based integrated delivery network (IDN).

Minnesota-based Allina Health’s home palliative care program has been working with three payers, with hopes to grow that number in 2020. The program currently has nearly 120 palliative care patients on its daily census.

“[Payers] don’t always understand the benefits that community-based palliative care can offer,” Julia Crist, vice president of operations for home and community services at Allina, said. “We’ve been working through that for the past year. After we get on the same page about how the program performs for beneficiaries, we have been successful in getting more and more contracts to cover it. With Medicare Advantage emerging, we see this as a growth area.”