A moving target in palliative care delivery is whether or not these services should have a dedicated benefit in the Medicare system. Discussions have heated up as to what such a program would mean for the industry.
Palliative care models vary widely, with some focusing on interdisciplinary pain and symptom management, and others on consults around goals of care, family caregiving support and social determinants of health. Providers have also increasingly leveraged telepalliative services.
This degree of variation is due in part to the disparate reimbursement pathways for palliative care, according to Dr. Andy Esch, palliative care specialist and senior education advisor at the Center to Advance Palliative Care (CAPC).
“No palliative program looks the same from area to area as far as the scope of diversity in services,” Esch told Palliative Care News at a recent conference from CAPC and the Coalition to Transform Advanced Care (C-TAC) in Washington D.C. “Part of this question in palliative care is asking whether we are okay with the diversity of models. The models are diverse because there’s not a sustainable payment model for it; there’s varying resources in varying areas. It’s looking at that as innovation. People have been really creative to do their programs in a way that is sustainable and provides value to the community that they’re servicing.”
Most palliative care in the United States is reimbursed through fee-for-service programs, as well as Medicare Advantage, Accountable Care Organizations (ACOs) and through Medicaid in a handful of states. To date, no dedicated payment model exists for palliative care, which leaves much room for interpretation of what should be included in these services.
To define such a model, stakeholders would have to leap some hurdles. They would need to develop a standardized scope of services, as well as quality measures, staff qualifications, Medicare Conditions of Participation and patient eligibility requirements, according to Allison Silvers, chief health care transformation officer of CAPC.
Establishing these standards could narrow the scope of who can receive and deliver serious illness care, she stated.
“What we’ve seen grow is the interest in now defining a model for palliative care. And I’m not sure that when we look at the patient diversity and patient needs that it’s even necessary for palliative care,” Silvers told Palliative Care News. “Palliative care is definitely a specialty that needs support, but the model has to allow for that diversity of services and professionals to evaluate and figure out what a patient needs. There are all sorts of programs to address palliative gaps in communities.”
An established benefit would need to include layers of interdisciplinary support not only around medical services, but also nonmedical as well, Silvers stated.
One crucial consideration would be standards around palliative care assessments that help drive quality metrics, she added.
“In terms of varying quality of what’s being delivered, a palliative care assessment should be kept as the north star to abating quality issues,” Silvers said. “It all starts with what’s in an assessment and defining what that comprehensive assessment should include. It’s regulating and understanding what happens in that conversation that starts conversations around palliative care.”
As the future of palliative care delivery unfolds, providers are at a pivotal evolutionary moment, according to CAPC CEO Brynn Bowman.
For instance, palliative care providers have the opportunity to help create a “blueprint” for quality standards that address the different domains of patient and family needs when it comes to psychological, social, spiritual, physical and existential suffering, Bowman said.
“We know what quality looks like to alleviate that suffering through palliative care,” Bowman told Palliative Care News at the conference. “In palliative care, we’re able to evolve simultaneously and reach this dream of a continuum of services that makes sense for patients. However, that means evolving where and how palliative care teams reach patients.”
Data around quality outcomes will be an important piece of shaping the future of palliative care regulations and reimbursement, she added. The ability to demonstrate palliative care’s cost-saving potential will play a key role in shaping these services in the years to come, Bowman stated.
“Access to palliative care isn’t standardized because there are not a lot of health plans and systems that are held accountable for providing access to it. Decision makers need sights on the data that there is still a disparity in palliative care access, largely because these are not seen as a revenue-generating service,” Bowman said. “But they actually result in cost savings of overall care when provided. It’s trying to translate that value into support of palliative care programs among health plans, payers and health system leaders. That’s a struggle.”