Strains on reimbursement, referrals and staffing represent the biggest obstacles to palliative care providers’ viability and growth.
It takes time to build up the payment, referral and workforce resources needed to support a sustainable palliative care program, according to Dr. Stephen Goldfine, chief medical officer at Samaritan Healthcare & Hospice. The New Jersey-based nonprofit offers hospice and palliative care, among other services.
“We’ve grown our palliative practice through a lot of education and getting physicians to understand what palliative care is and how it can help patients focus on their goals of care, quality of life and symptom management,” Goldfine told Hospice News. “It began with really good traction to our referral sources and creating efficiencies around interdisciplinary care management. It was showing hospitals and others in health care that our specialists can help manage symptoms earlier in a serious disease. But it takes time to get to that productivity level.”
Samaritan Healthcare & Hospice launched its palliative care service line in 2007, mainly providing these services in hospital-based settings. Samaritan’s Palliative Medical Partners provided 17,000 patient visits during 2022 across eight hospitals in south New Jersey, Goldfine stated.
The palliative care provider has referral partnerships with Virtua Health, Jefferson Heath and Saint John of God Community Services, among other health care providers in the area.
Samaritan’s program has since grown to additionally offer community-based palliative care and telehealth palliative services across three counties in the state’s southern region.
Health care providers looking to expand into this type of serious illness care should start small in terms of patient volume, clinicians’ caseloads and managing their expectations around return on their investments, Goldfine stated.
“If you go into palliative care thinking you’re going to make a lot of money at it, then you’re in the wrong business,” Goldfine told Hospice News. “Palliative care is really a community resource that focuses on the community’s needs and provides the best level of care. You want to make sure clinicians have time to see patients and have some financial viability in the process. Many of these programs don’t make a lot of money, they actually lose money. Oftentimes, that’s because they’re spending a lot of time understanding services involved and payments available for them.”
If you go into palliative care thinking you’re going to make a lot of money at it, then you’re in the wrong business. Palliative care is really a community resource that focuses on the community’s needs and provides the best level of care.— Dr. Stephen Goldfine, chief medical officer, Samaritan Healthcare & Hospice
Hospices are among the health care providers that are increasingly looking to diversify their services to include palliative care services.
More than half (56%) of nearly 330 hospice professionals indicated that their organizations planned to launch palliative care programs for the first time during 2023 in this year’s Hospice News’ Industry Outlook Survey, prepared in collaboration with Homecare Homebase. This marks a climb from 52% last year.
The ability to scale a palliative care program comes with an understanding of how reimbursement takes shape within the scope of Medicare, Medicaid and private insurance realms, according to Lynn Spragens, founder and partner of Spragens & Gualtieri-Reed, a North Carolina-based health care consulting company.
The varied mix of available palliative payment streams means that providers must take a collaborative approach to care delivery in order to thrive and grow these services, Spragens said, speaking at the American Academy of Hospice and Palliative Medicine (AAHPM) and the Hospice and Palliative Nurses Association (HPNA) Annual Assembly.
“A small number [of payers are] commercial, and then you’ve got Medicaid and several government payer pieces, with Medicare tending to be viewed as a lower payer for these services,” Spragens said. “[Palliative] specialists deal with the most complex sick patients that are going to have a potentially higher proportion of Medicare and Medicaid patients. That’s a different payer mix. So, it’s understanding that, and then talking about the importance of better payment to build the storyline for them to follow you on. It also raises the bar on collaboration with geriatric populations.”
Palliative care providers can expect the payment environment to keep evolving, according to Allison Silvers, chief health care transformation officer at the Center to Advance Palliative Care (CAPC). For instance, more Medicaid managed care plans are integrating payment avenues for palliative services, she stated.
Understanding the various palliative care payment mechanisms is crucial, along with having varied interdisciplinary specialists that can communicate the value proposition of these services to referring clinicians, Silvers said at the AAHPM/HPNA assembly.
“About 41 states now have managed Medicaid. There’s also quite a lot of activity going on with state hospice and palliative care associations becoming more involved in political discussions about palliative benefits or folding them into existing benefits,” Silvers said. “This is something where the field continues to evolve. But to prepare your program, start with the demographics to just paint a picture that there’s a big difference between pure Medicare patients, Medicaid beneficiaries, and dual eligible beneficiaries, and how your program needs to be able to meet those varied needs. To the extent possible, having a diverse staff that represents the community you serve is invaluable, and so is collaborating with community-based providers serving seniors in your area.”