Payment models that could change under a new presidential administration have raised questions about the future business of hospice in 2021. Recent regulatory moves and the federal response to the coronavirus pandemic may be indicative of what’s to come for hospice and palliative care providers.

The arrival of a new president during a national public health emergency could lead to rippling change in the health care system. The coronavirus pandemic is anticipated to take center stage in the first 100 days of the Biden administration. The president-elect stated in his November victory speech that getting the virus under control would be his administration’s top priority in 2021, and called for senior care and caregiver support as part of a $775 billion package to extend Medicaid benefits.

Biden also pledged to enhance the existing structure of the Affordable Care Act and laid out plans to expand Medicare access by lowering the eligibility age from 65 to 60. This would vastly expand the number of people with access to the Medicare Hospice Benefit, as well as emerging payment models.

“Over the last two years we’ve seen an explosion of federal support for alternative payment model demonstrations that target either fully or partly-focused on a seriously ill, complex chronic illness population,” said Davis Baird, policy and advocacy manager for the Coalition to Transform Advanced Care (C-TAC) during a recent webinar. “We need to figure out as a field what is the right number of simultaneously running demonstration models because there are a lot of them right now.”

The Primary Care First initiative and the Seriously Ill Population payment programs are expected to have reaching impacts on hospice and palliative care providers, as will a drive to mold Medicare and Medicaid programs into value-based care payment models that tie reimbursement to quality of care, with rewards for health care providers that demonstrate efficiencies and cost-savings.

Medicare Advantage plans will carve-in a hospice component beginning January 2021, in a value-based insurance design demonstration that could alter the way hospices do business during the next four years. The recently announced Geographic Direct Contracting Model is a value-based initiative designed to improve health outcomes and reduce the costs for Medicare beneficiaries.

“All these models taken collectively really represent this kind of sea change at the federal administration level as far as committing to innovative payment mechanisms to focus narrowly on the unique needs of a seriously complex chronic population,” said Baird. “We are seeing more members of Congress on a bipartisan basis being interested in improving care for this population. The issue around value-based care is bipartisan, and this push to keep the foot on the gas is really encouraging. I would say that the incoming Biden administration is going to be full-steam ahead on value-based care.”

Regulatory swings are on the horizon in the wake of a flurry of federal activity in recent weeks.

“There has been a flurry of activity, both regulatory and on the executive side with a whole bunch of rules that have come out in the last days of the Trump administration,” said Marian Grant, C-TAC’s senior regulatory advisor, during the webinar. “Many of the key health care priorities under the Biden administration are going to have serious illness components. It’s going to be interesting to see how much the Biden administration can or can’t get done through whatever Congress they end up with in January after the run-off elections in Georgia for the Senate.”

Early voting began Monday in Georgia for two runoff elections that will determine Democratic versus Republican control of the Senate. Regardless of divisions across the aisle, Congress in the early days of the pandemic pushed forward funding to support health care providers. Tense negotiations among lawmakers led to the Coronavirus Aid, Relief and Economic Security (CARES) Act that provided aid to organizations taking on pandemic-related hits.

More federal support may be on the way during the pandemic, including regulatory changes that could affect hospices.

“The pandemic has been an eye opener for many policymakers on the need to address serious illness issues, and highlighted the need to ensure accessibility and use of advance care planning,” said Brian Lindberg, public policy advisor for C-TAC and executive director of the Consumer Coalition for Quality Healthcare. “We’re energized and optimistic about the 117th Congress and the Biden-Harris administration, whether it is divided or not. There are good opportunities to educate and advocate for a higher appreciation of advance care planning now that are tied to the pandemic, and good opportunities for bipartisanship and bicameral support.”