The palliative care field can expect to see continued growth during 2020 despite the lack of a dedicated Medicare payment model, a continued need to raise public awareness, and ongoing staffing shortages.
About half of the community-based palliative care providers in the United States are hospices, according to recent research from the Center to Advance Palliative Care (CAPC). CAPC developed an online survey to which 890 palliative care providers responded.
Interest in palliative care has been rising in recent years among health care providers, payers and policymakers, driven by the benefits to patients, the need to engage patients earlier in the course of their illnesses, and the potential cost savings from reduced hospitalizations, readmissions and emergency department visits.
“Palliative care growth will continue at a very fast pace,” Tom Koutsoumpas, co-founder of the Coalition to Transform Advanced Care and CEO of the National Partnership for Hospice Innovation, said. “The knowledge and acknowledgement of palliative care has increased dramatically, and I think that’s been such a positive thing for providers for patients for families, because there’s a clear recognition of the importance of palliative care.”
While the field has received more attention, more work needs to be done to raise awareness.
Though CAPC reports that nearly 80% of consumers who received background information on palliative care would choose it for themselves or their loved ones, nearly 60% of patients who would benefit from those services do not receive them, studies have shown.
One study published earlier this year found that 71% of adults in the United States are unaware that the service exists, but some, including government resources and hospice providers themselves, have taken action to help address this.
A number of states passed legislation designed to support palliative care during 2019. As of Dec. 2018, 27 states had laws on their books designed to promote palliative care, according to the National Academy of State Health Policy (NASHP). Though details of the legislation vary among the states, they each serve the goal of bringing palliative care to more patients with serious, chronic, or life-limiting conditions. The number has now risen past 30.
At the federal level, 2019 saw the formation of a new U.S. Senate caucus with the goal of expanding access to palliative care nationwide.
Providers are also looking towards the future, with new payment models that will likely impact palliative care set to begin in 2021.
“I think 2020 is a big preparation year, and from an association perspective, a big communication year to see if it’s there are tweaks and things that can be done to make the models work better for participation palliative care providers in advance of them rolling out and getting started so that they can roll out as smoothly as possible,” said Mollie Gurian, director of hospice, palliative and home health policy at LeadingAge, told Hospice News. “The palliative care community is thinking about how to partner to increase the presence of palliative care across our [health care] continuum. We expect to see continued momentum in that space.”
The forthcoming payment models include the Medicare Advantage hospice carve-in as well as the U.S. Centers for Medicare & Medicaid Services’ (CMS) Primary Care First initiative, with its associated Serious Illness Population model and direct contracting programs.
While aspects of these payment models look promising, they stop sort of being a dedicated palliative care benefit, which is difficult to design in the absence of a standardized consensus definition of what palliative care is.
In the absence of a national model, the state of California has implemented a program to cover palliative care through its Medicaid plans, and some hospice and palliative care providers have taken steps to negotiate directly with payers to secure coverage for their services while reducing the payers’ costs.
Research has indicated that expanded access to palliative care could reduce societal health care costs by $103 billion within the next 20 years. 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.
Advocates in the space have called for CMS to step up to the plate to address the matter of palliative care payment.
“Palliative care continues to be a bit of a unicorn that we all talk about. Although there is a medical specialty called palliative medicine, Medicare doesn’t have a community benefit called palliative care,” Edo Banach, president and CEO of the National Hospice & Palliative Care Organization (NHPCO), told hospice news. “I do think that in in the coming year, efforts are going to intensify to create an actual palliative care benefit that you can wrap your arms around — a real fee-for-service benefit that below which you can’t call it palliative care, and above which you can call it high quality palliative care.”