Interest in palliative care is rising among job-seeking clinicians, but the influx remains too slow to meet rising demand.
A lack of available training and generally poor understanding of palliative care among clinicians and the public have long been barriers to growth. However, that paradigm may be starting to shift due to a series of changes in the health care system.
Though far more resources are needed, more opportunities for clinical palliative care training have been emerging in recent years, according to Dr. Nathan Goldstein, currently professor of geriatrics and palliative medicine at Icahn School of Medicine at Mount Sinai.
“From a physician standpoint, the palliative care fellowships now are oversubscribed in a way they never happened before. We’re seeing more and more nurse training programs, more social work training programs, etc., and the number of palliative care programs out there is increasing in academic medical centers,” Goldstein said during the Hospice News Virtual Staffing Summit. “We’re putting more people out there in the world through these training programs.”
Goldstein will soon become professor and chair of the Department of Medicine at Dartmouth-Hitchcock in Vermont.
A range of factors is driving these changes. One is the movement of more health care into the home setting, a trend that was accelerated by the pandemic. That, coupled with an overarching need to control costs by reducing avoidable hospitalizations, has spurred more stakeholders to take a closer look at palliative care.
Case in point, the palliative care framework utilized within the Center for Medicare & Medicaid Innovation’s (CMMI) Medicare Care Choices Model (MCCM) reduced total Medicare spending among beneficiaries served by 14%, with total savings per patient reaching $7,254, according to a recent evaluation of the program.
Palliative care also decreased ED visits by 14% and inpatient admissions by 26% while boosting hospice enrollment by 29%.
But business trends are also driving change. As the value of palliative care becomes more apparent, investment in the space is rising. This influx of capital is driving more providers to expand their palliative care programs.
In tandem with these investments is the rise of managed care, such as Medicare Advantage plans and some Accountable Care Organizations (ACOs). These entities often offer reimbursement models that better support the full spectrum of interdisciplinary palliative care than traditional fee-for-service programs.
“There’s this tremendous push of palliative care in the community, particularly in these managed care programs, venture capital, private equity coming in and setting up,” Goldstein told Hospice News. “They’re really trying to fill in this space, and they’re using per-member per-month, managed risk-sharing arrangements.”
The advent of these payment models can make it easier for providers to support a full palliative care team — as long as those clinicians are available for them to hire.
Though staffing shortages persist throughout the palliative care space, but for providers in rural or other less-populated regions these challenges are particularly difficult to manage due to a smaller labor pool, according to Rebecca Doleman, vice president of palliative care programs for InHome Connects, the palliative care arm of Heart to Heart Hospice.
InHome Connects, which currently operates primarily within a fee-for-service model, will be expanding into more value-based arrangements during 2024. While this won’t eliminate the industry-wide staffing pressures, it should have a beneficial impact on recruitment, Dolman said during the Staffing Summit.
“Being able to stand in a per-member, per-month contractual agreement with a payer really changes the game significantly,” Doleman told Hospice News. “When there’s a contractual agreement, I have the ability to open up to other roles that are not billable exclusively. When you have a market space that is primarily being driven by a set reimbursement model, it allows a program to really be creative to identify the specific needs of that set of patients and then build out an interdisciplinary team to best support those needs.”
