Four U.S. senators have introduced a bipartisan bill that would direct the Center for Medicare & Medicaid Innovation (CMMI) to develop a palliative care-specific payment model demonstration.
The bill’s sponsors include Sens. Jacky Rosen (D-Nev.), John Barrasso (R-Wy.), Tammy Baldwin (D-Wisc.), and Deb Fischer (R-Neb.). The four legislators in 2019 co-founded the Senate’s bipartisan Comprehensive Care Caucus to focus on legislation and policy to raise awareness of and improve access to palliative care.
Among the bill’s priorities is ensuring that patients can access palliative services earlier in their disease trajectory, according to Rosen.
“Palliative care has been shown to improve health outcomes and quality of life, but unfortunately, for seniors, it is only currently available to patients in hospice,” Rosen told Palliative Care News in an email. “That’s why I’m introducing bipartisan legislation to expand Medicare coverage of palliative care, making it available to seniors earlier in the diagnosis and treatment process. As a co-founder of the Senate’s Comprehensive Care Caucus, I’ll always work to improve the quality of life for patients and their families.”
A dedicated community-based palliative care benefit has been high on many providers’ wish lists for many years. To date, the limited avenues for reimbursement have been a barrier to palliative care growth.
Currently, CMS covers palliative care physician or licensed independent practitioner services through Medicare Part B, which does not support the full interdisciplinary model. Additionally, some Medicare Advantage plans offer palliative care as a supplemental benefit.
Some Accountable Care Organizations (ACOs) also contract with palliative care providers, which often involves shared savings arrangements.
“There are many benefits in allowing patients to seek palliative support through early referrals. Our hospice and community-based palliative care providers are uniquely positioned to deliver this model of care,” Ben Marcantonio, COO and Interim CEO of National Hospice and Palliative Care Organization, said in a statement. “Their long-standing expertise in advance care planning, pain and symptom management, interdisciplinary care and more, make these organizations ideal entities to deliver a model of care in support of people and families dealing with serious illness at home.”
Close to half of community-based palliative care programs are operated by hospice agencies and 7% are operated by home health operators, according to 2019 data from the Center to Advance Palliative Care and Palliative Care Quality Collaborative.
A significant number of palliative care programs nationwide are supported through philanthropy, while others use the service as a loss leader that can help boost hospice referrals.
With such a fragmented reimbursement structure, wide variations often exist among different providers’ palliative care models, and the available payment opportunities can also vary from market to market.
“As a doctor, I have seen firsthand how important palliative care is for the comfort of patients and their families,” Barrasso said in a statement. “Making sure patients have access to this care as soon as possible is critical to their quality of life. Our bipartisan bill ensures patients who need this care in Wyoming and across the country continue to receive the highest quality of care they deserve.”