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With the palliative care space in a state of flux, some experts in the field see cause for optimism as well as real questions about what these services will look like, as well as the structures that support them.
“Palliative care” is becoming a buzz word in health care, even if many people don’t understand the loosely defined term. However, wide variation exists in how different providers deliver these services in the absence of a standardized, national definition or a more concrete regulatory structure that includes quality measures, Logan Hoover, vice president of policy and public relations for the National Hospice and Palliative Care Organization (NHPCO), said at the Hospice News Palliative Care Conference in Tampa, Florida.
“Volatility is the right word. That can be really beneficial, and it can also be a detriment. So, the flexibility in the model and how it is delivered, or what constitutes palliative, or what the teams look like, I think the benefits of that is it’s very flexible,” Hoover told Palliative Care News at the conference. “But then the problem is that it’s hard to reimburse and it’s hard for everyone to know what exactly palliative care is. So, the state [of palliative care] is on the move. a little fractured, but I think there’s some cause for optimism.”
The palliative care field emerged in the United States during the 1980s, shortly after the Medicare Hospice Benefit came into being, according to research from Johns Hopkins Medical. Since then it has taken a winding course through the health care system.
While some providers offer a full scope of interdisciplinary care, some palliative care programs only offer physician consulting services or advance care planning. Others limit services to certain types of support for pain management. This broad brush can be confusing for referral sources, payers and patients and families who may not understand what they are getting or what else may be available to them.
Having a more defined scope of service can help dispel misconceptions and negative connotations associated with the term “palliative care,” according to Brynn Bowman, CEO of the Center to Advance Palliative Care (CAPC).
“There’s the issue of the branding and language of palliative care. Forever, there’s the issue of conflation between end-of-life care and hospice and palliative care. When we think about what that means, in terms of when providers have further questions about palliative care or about what that means to patients where they’re offered palliative care,” Bowman told Palliative Care News at the conference. “This goes back to the issue of standardization, to the extent possible, of what is community-based palliative care. Because if there is a consistency in what patients can expect from those services, we can start to dispel those misperceptions.”
Palliative care, depending on how it’s delivered and paid for, can help drive change in the health care system, in terms of cost reductions, improving outcomes and making care more patient-centered. But while the flexible definition of those services can give providers room to innovate, positive change has been slow going, Scott Levy, chief government affairs officer for Amedisys (NASDAQ: AMED).
“There are incremental signs, because in a lot of the discussions that we’re having on the provider level, there is a desire for referrals to see some sort of palliative care,” Levy said at the conference. “But again, I think it’s kind of amorphous in what it looks like and they don’t really know what they’re asking. It goes with a lot of the stuff we’re hearing on innovation. Everybody wants to innovate. But what exactly do you mean when you talk about innovating?”
Amedisys provides palliative care largely through its high-acuity segment, Contessa Health, which pursues risk-based payer relationships to support its program. In February of last year, Contessa penned a contract with Blue Cross Blue Shield of Tennessee that included making palliative care available to its Medicare Advantage plan members.
Payment models are partly at the crux of some of these questions in palliative care. This is because reimbursement structures tend to come with a regulatory framework, quality measures and a defined scope of service.
Currently, palliative care providers can find reimbursement through Medicare Part B for physician services, and also through supplemental benefits included in Medicare Advantage. Other reimbursement options exist in payment arrangements with Accountable Care Organizations (ACOs) and Managed Services Organizations (MSOs).
About a dozen states have integrated some form of specialized palliative care service benefits into their Medicaid programs, according to a 2022 report from the Texas Health and Human Services Department.
One emerging reimbursement trend is the Center for Medicare & Medicaid Innovation’s (CMMI) development of payment models that incorporate elements traditionally associated with palliative care, but without using those words. Examples include the Guiding an Improved Dementia Experience (GUIDE), the Kidney Care Choices and Enhancing Oncology models.
The GUIDE model, for example, includes language requiring “person-centered care meant to improve quality of life, delivered by interdisciplinary teams.”
“That is palliative care language,” Bowman said. ”It does not include payment for palliative care. But it recognizes caregivers’ care; it recognizes social needs. We see places where sort of the needs that palliative care intends to address are infiltrating into models that health care gets paid for, it just hasn’t so much translated into a standardized model of specialty palliative care for those patients who really need that service.”
