Members of the congressional physician’s caucus have written to U.S. Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma to advocate for a Medicare palliative care benefit demonstration. Reps. Neal Dunn, M.D (R-Fla), Phil Roe, M.D. (R-Tenn.), Jeff VanDrew (D-N.J.), and Sen.-Elect Roger Marshall (R-Kan.) signed the letter.
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.
“There is a significant evidence base to support the need for a [Center for Medicare & Medicaid Innovation]-supported community-based palliative care effort that would lead to improved quality and cost outcomes for beneficiaries experiencing serious illness,” the Congress members wrote to Verma. “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.”
Hospices provide about 50% of community-based palliative care in the United States, according to the Center to Advance Palliative Care, but the lack of a dedicated payment model is a barrier to further growth.
Medicare typically reimburses for palliative care physician services through fee-for-service payment structures, which generally do not pay for the full range of interdisciplinary palliative care.
Medicare Advantage plans have the option to cover palliative care as a supplemental benefit. According to an analysis by ATI Advisory, 61 health plans nationwide offered in-home palliative care as a benefit this year. This is up from 29 in 2019. More than 455,000 beneficiaries are enrolled in these plans. However, the plans that are offering in-home palliative care are concentrated in relatively small geographic areas.
The Primary Care First initiative includes a Serious Illness Population payment model that could include payment for palliative care, either directly or through partnerships with primary care practices. The program will not be available in all 50 states, at least during its first year. While these programs may make a difference, they likely would fall short of the impact of a dedicated benefit.
Industry organizations such as the National Hospice & Palliative Organization (NHPCO), the National Association for Home Care & Hospice and the National Coalition for Hospice and Palliative Care have argued that the pandemic makes the need for such a benefit all the more pressing. This fall more than 60 organizations wrote to federal health care officials requesting a palliative care demo.
“We believe such a demonstration would improve the quality of care for patients with serious illness or multiple chronic conditions, protect high-risk individuals from unnecessary exposure to COVID-19 and other dangers, reduce the occurrence of preventable hospitalizations and emergency department visits, utilize a limited workforce more effectively, enhance the use of telehealth, and reduce total cost of care for this target population,” the Congress members said in their letter.