Support is building in Congress for the establishment of a dedicated community-based palliative care benefit through Medicare. Ten members of the U.S. House of Representatives Ways & Means Committee have written to Chiquita Brooks-LaSure to call for a demonstration to test such a benefit. Brooks-LaSure is administrator of the U.S. Centers for Medicare & Medicaid Services (CMS).
Establishing a dedicated Medicare benefit has been a priority for providers and industry groups for several years. The hospice community has been a driving force in the advancement of community-based palliative care. About 50% of palliative care providers in the United States are hospices, according to 2020 data from the Center to Advance Palliative Care. Most of the remaining providers were health systems.
“Providing care at home allows some of our most vulnerable populations to remain safe from communicable disease, comfortable, and surrounded by loved ones; it can also alleviate the burden on our nation’s hospitals and other inpatient settings,” the Congress members wrote. “The goal is to improve the quality of life and beneficiary and family satisfaction with care at the end of life, inform new payment approaches for the Medicare program, and reduce Medicare expenditure.”
While the availability of palliative care is improving, fewer than 5% of patients with serious illnesses who stand to benefit from palliative care actually receive it, according to a May 2019 report by the National Academy of State Health Policy.
In addition to the benefits for patients and families, home-based palliative care could reduce societal health care costs by $103 billion nationwide within two decades, the nonprofit economic research group Florida TaxWatch reported in 2019.
Currently, Medicare reimburses for palliative care physician and licensed independent practitioner services through fee-for-service payment programs that often do not sufficiently support the full range of interdisciplinary care.
The closest existing equivalent to a palliative care benefit is the CMS’ test of the Medicare Care Choices Model (MCCM), which allows hospice patients to receive curative care concurrently with hospice. The agency recently announced that it was extending the program by one year. The test was originally scheduled to close at the end of 2020.
A new demonstration from the Center for Medicaid & Medicare Innovation (CMMI) would likely contain elements pioneered through the MCCM, which the Ways & Means Committee members noted in their letter.
“The MCCM model has tested whether allowing for some flexibility in the types of services available to hospice enrollees improves quality of life and satisfaction with the benefit, while reducing costs,” the members wrote. “Expanding MCCM to allow for pre-hospice community-based palliative care or launching a new model may help examine some of the reasons why the rate of uptake of hospice and other end-of-life services among certain populations, including people of color, is low and care delivery is more fragmented.”
Signatories of the letter included Steven Horsford (D-Nev.), Thomas Suozzi (D-N.Y.), Danny Davis (New Party-Ill.), John Larson (D-Conn.), Jimmy Panetta (D-Calif.), Terri Sewell (D-Ala.), Mike Thompson (D-Calif.), Ron Kind (D-Wisc.), Brian Higgins (D-N.Y.), and Earl Blumenauer (D-Ore.).
The House Ways & Means Committee is among the most influential in Congress. It has jurisdiction over all taxation, tariffs and other revenue-raising activities, in addition to Social Security, Medicare, unemployment benefits, child support laws and a range of other federal programs.
The U.S. Senate has also had palliative care on their agenda. The four founding members of the Senate Comprehensive Care Caucus recently introduced the Expanding Access to Palliative Care for Seniors Act, which if enacted would push CMMI to begin work on a community-based palliative care demonstration. While CMMI has the authority to test new models without congressional action, the bill could accelerate the process.
The hospice community, long plagued with a shrinking workforce, hailed the lawmakers’ action.
“Members of Congress are coalescing around the need for a community-based palliative care benefit demonstration project. This momentum is the next step in a process driven by advocacy of a unified hospice and palliative care community,” National Hospice & Palliative Care Organization President and CEO Edo Banach said. “We are grateful to work closely with Congressional leaders who understand that CBPC can make access to care more equitable, reduce costs, deliver better care and improve patient quality of life.”
Companies featured in this article:
