A transition from fee-for-service to value-based payment models could help palliative care providers boost recruitment and retention.
Providers walk a tightrope when it comes to ensuring that their palliative care services are financially sustainable, including the ability to attract and compensate staff at competitive rates. In today’s predominant reimbursement structure, palliative care programs are often loss leaders.
But moving away from fee-for-service towards value-based payment could make a difference when it comes to hiring and retention, according to Dr. Jennifer Blechman, palliative care medical director at the Oregon-based nonprofit Partners in Care.
“Palliative care traditionally loses money. The value in palliative care is cost savings. We lose money on the palliative care side, but we gain money in other departments. We have a longer length of stay on hospice, which allows us to continue to do palliative care by bringing in more to our hospice side,” Blechman said at the Hospice News Virtual Staffing Summit. “With the value-based payment models, we would be compensated to help keep good quality of life and help keep people out of the hospital and emergency room. More compensation into the company would allow us to hire more and to reflect that in salaries.”
Primarily and palliative care providers can bill for physician services through Medicare Part B, and also through supplemental benefits included in Medicare Advantage. Other reimbursement options exist via payment arrangements with Accountable Care Organizations (ACOs) and Managed Services Organizations (MSOs).
Palliative care is also part of the hospice component of the U.S. Centers for Medicare & Medicaid Services’ (CMS) value-based insurance design (VBID) demonstration, which is slated to end on Dec. 31.
As they seek out value-based payment, many providers are turning to the Center for Medicare & Medicaid Innovation’s (CMMI) recently introduced Accountable Care Organization Realizing Equity, Access and Community Health (ACO REACH) model, particularly the high-needs population track.
Among those providers is Nevada-headquartered Infinity Hospice Care, which operates an ACO REACH program in its home state.
“Our strategy depends on the market. In Phoenix, our palliative care team was really sort of embedded with the hospice and the strategy of building a team is really sort of old school palliative care,” Infinity Hospice Care CEO Darren Bertram said during the summit. “In in Las Vegas, that’s where we have our regional ACO REACH, we are focused on value and the cost of these patients.”
ACO REACH reflects CMMI’s redesigned strategy for payment system demonstrations, with advancing health equity as a key tenet. The program places a greater focus on addressing health care disparities, the agency indicated, as well as a stronger emphasis on screening and monitoring of model participants to foster transparency and prevent inappropriate coding and risk score growth.
Contracted agencies would have to choose between a Total Care Capitation option or a Primary Care Capitation option. This would be a capitated, risk-adjusted monthly payment for enhanced primary care services equal to 7% of the total cost of care.
The shared savings components of value-based models could allow providers to increase staff compensation, which could enable them to better compete with other health care employers like hospitals, according to Bertram.
“When we think about the workforce shortage, there’s lots of people, but there’s just so many jobs. You have to distinguish yourself as to what you’re doing and make sure your compensation is competitive,” Bertram told Palliative Care News. “In building your team the challenge is fitting together your revenue stream and your patient population to be able to take care of that patient faction with the revenue you are bringing in so you can competitively compensate.”
