Progress on growing access to quality palliative care has been challenged by hurdles in policy, payment and common misperceptions among patients and providers.
Palliative care providers can help patients and families at various points along their health care trajectories, but the fragmentation in the nation’s health system has led to widespread access issues, according to Jon Broyles, CEO of the Coalition to Transform Advanced Care (C-TAC).
“It can be hard to put together the right resources, and that’s [partly] with systematic failures in public policy,” Broyles said at the C-TAC–Center to Advance Palliative Care (CAPC) Leadership Summit. “It’s ways for palliative care to become almost the norm for us to think about focusing on the patient, caregiver, interdisciplinary teams, community needs, and all of these things that are great foundations to build on.”
Slow progress toward greater awareness
As palliative care policies take shape, they should include standardized mechanisms for guiding providers on ways to communicate the nature of their services in more clear and consistent ways, according to Allison Silvers, chief health care transformation officer at CAPC.
Misconceptions around palliative care often involve health providers and patients and families conflating these services with hospice. Breaking down these misunderstandings with more standardized communication guidelines could be one direction towards clarity and improved awareness, Silvers said.
“It’s letting patients, families and other clinicians know that this is support along the way,” Silvers told Palliative Care News at the summit. “All of that language has to change and has to be a big part of what people need to focus on. There’s a lot of tolerance for the ‘wrong’ language, something that would be great to see more policed in our policies somehow.”
Changes in palliative care delivery have been “slow, but important,” according to Brynn Bowman, CEO at CAPC. One key to improving palliative support is growing awareness and awareness among clinical teams across the care continuum, according to Bowman.
“It’s important that palliative care understanding grows among clinicians that it isn’t about the end of life and hospice. It’s so key as a gatekeeper for so many patients to have doctors that understand when it is and isn’t time for palliative care,” Bowman told Palliative Care News. “That’s so critically important to do a lot of education with non-palliative clinicians about how to collaborate with palliative care teams, how they can be of help and what kinds of services that your patients will get.”
Reimbursement key to access, scale
Expanding palliative education among health care professionals across the continuum is an important part of making conversations around serious illness care more “automated” and “normalized,” according to Dr. Andy Esch, a palliative care specialist based in Florida who also serves as senior education advisor at CAPC.
But to sufficiently scale palliative care services, providers will need a more robust reimbursement system, Esch said. One concern is that as demand for palliation grows, providers’ care delivery approaches will vary too widely, complicating efforts to create quality measures, payment models and to foster greater awareness, he said.
Currently, Medicare reimburses for palliative care via fee-for-service systems that do not cover the full range of interdisciplinary care. Some coverage is available through Medicare Advantage and Accountable Care Organization (ACO) relationships, but these are not available in every market. Consequently, many patients fall through the cracks.
Esch called for the establishment for a dedicated palliative care benefit within Medicare that includes reimbursement for the full scope of care.
“My concern for the field is sort of the part of that innovation and doing what you can with the resources you have has given way to enough concern about the devaluation of the non-billable provider in palliative care because of market forces,” Esch told Palliative Care News at the C-TAC-CAPC summit. “I think a lot of health systems are hiring people that can generate palliative care visits when really it’s the interprofessional team approach that delivers the best care possible. One provider on a team can’t do this work, you need different members at different times – that approach is essential to really meet the needs of patients and families. I hope that we continue to push for the importance of that.”
