More than 60 Organizations Call for Medicare Palliative Care Demo

The U.S. Department of Health and Human Services (HHS) and congressional leaders have received letters with signatures from more than 60 health care and senior citizen advocacy groups calling for a demonstration to test a community-based palliative care benefit program within Medicare.

Organizations such as the National Hospice & Palliative Care Organization (NHPCO), the National Coalition for Hospice & Palliative Care, the National Association of Home Care & Hospice, and the Center for the Advancement of Palliative Care (CAPC) were among the letter’s signatories, in addition to dozens of other organizations.

“A community-based palliative care demonstration is especially critical now because it can safeguard the health of vulnerable patients and families against possible transmission of COVID-19 by providing care where the patient lives,” said NHPCO President and CEO Edo Banach. “These community-based services provide better outcomes for patients and can reduce the costs of care. We believe the time is right to start this demonstration and continue to innovate how we deliver health care in this country.”

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The letter asked HHS Secretary Alex Azar and U.S. Centers for Medicare & Medicaid Services (CMS) to develop a demonstration program through the Center for Medicare & Medicaid Innovation.

CMS tests the viability and functionality of new payment models and other initiatives through demonstration projects. The Medicare Hospice Benefit began as a demonstration project several years before it was made permanent. CMS in 2021 will begin a demonstration project to test the inclusion of hospice in the value-based insurance design model, often called the Medicare Advantage carve-in. 

Hospices currently provide about 50% of the community-based palliative care in the United States, according to CAPC.

While no standardized definition exists for “palliative care,” CMS defines the term as “patient and family-centered care that optimizes quality of life by anticipating, preventing, and treating suffering. Palliative care throughout the continuum of illness involves addressing physical, intellectual, emotional, social, and spiritual needs and to facilitate patient autonomy, access to information, and choice.”

Community-based palliative care has been shown to generate significant savings in health care costs, reduce hospitalizations and emergency department visits and improve the quality of life for patients who suffer from serious or chronic illness.

Florida TaxWatch, a nonprofit economic research group, reported last year that home-based palliative care could reduce overall societal health care costs by $103 billion nationwide during the next two decades.

Stakeholders in the palliative and serious illness care community have been vocal during the pandemic regarding the potential benefits of palliative care to aid patients suffering from the COVID-19 virus and help limit the spread. The letter cited this as an impetus to move quickly on a palliative care CMMI demonstration.

“A community-based palliative care demonstration would enable access to a specially-trained interdisciplinary clinical team providing relief from symptom distress while the patient continues to pursue curative treatment,” the organizations said in the letter. “This is especially important for seriously ill patients with comorbidities who are battling conditions such as COVID-19.”

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