Hospice reimbursement trends influence palliative care payment and delivery.
Among the significant changes coming this year is the end of the hospice component of the value-based insurance design (VBID) model, as of Dec. 31. Commonly known as the “carve-in,” the program was designed to test hospice care coverage through Medicare Advantage, as well as some coverage of palliative care and transitional care.
The end of the hospice carve-in could delay efforts to improve palliative care reimbursement models, according to Stephanie Adair, vice president of hospice services at Liberty HomeCare & Hospice Services. The North Carolina-based hospice, home health and palliative care provider is part of the Liberty Health system.
“The VBID models provided incentives to providers to deliver high quality care as well as cost-effective care,” Adair told Hospice News in an email. “The loss of the additional funding and resources could affect the range and depth of services offered by palliative care. Some providers struggle to provide an interdisciplinary model of palliative care because the traditional fee-for-service reimbursement is so low.”
Hospice carve-in’s lasting impact
Hospices represent a large portion of the community-based palliative care providers nationwide. At least half of all in-home palliative providers are hospices, reported the Center to Advance Palliative Care (CAPC).
The hospice component of VBID launched in 2021 as part of a larger demonstration, which covers a swath of the health care continuum.
The palliative care coverage in VBID allowed hospices stronger reimbursement for these services based on quality and outcomes, according to Adair. The hospice carve-in’s sunset could mean higher out-of-pocket costs for patients and their families as a result of lagging palliative payment pathways, she indicated.
The end of the carve-in could also slow progress on the development of standardized quality palliative care measures, Adair stated. Value-based payment models such as VBID incentivize quality measurement and reporting among providers. The emphasis on outcomes within value-based reimbursement could have opened doors to shaping and defining palliative care quality without a federally established palliative care benefit in place, she explained.
New approaches to palliative care reimbursement are necessary and should focus on improving quality and inspiring clinical innovation, Susan Ponder-Stansel, president and CEO of Florida-based Alivia Care Inc., said at the National Association for Home Care & Hospice’s (NAHC) Financial Management Conference in Las Vegas. The association recently moved forward in its affiliation with the National Hospice and Palliative Care Organization (NHPCO), forming the NAHC-NHPCO Alliance.
Alivia Supportive Care launched in 2020 as the nonprofit’s home-based palliative care service line. These interdisciplinary services help patients navigate chronic conditions and serious illnesses.
When it comes to payment models, a key challenge is defining and measuring quality, Ponder-Stansel indicated.
“Working on quality measures is where I think things get [challenging] for regulators and legislators,” she told Palliative Care News at the conference. “When you start to define who practices it, what are the outcomes and how you pay for it — that’s where everybody gets tripped up, because it’s done in so many ways right now.”
Palliative care coverage was a big part of the VBID demonstration for hospice providers, according to Healthcare Provider Solutions Inc. CEO Melinda Gaboury. Though the hospice carve-in has ended, a growing number of Medicare Advantage plans cover some form of palliative care, she explained.
Many Accountable Care Organizations (ACOs) also provide or pay for palliative care.
Medicare Advantage provides coverage to more than half of Medicare-eligible beneficiaries nationwide, reported the U.S. Centers for Medicare & Medicaid Services (CMS). Nearly 90% of these beneficiaries are seniors 65 and older, which represent a large bulk of hospice and palliative patients, the CMS report found.
Hospices offering palliative care services should carefully be watching these trends to prepare for their potential future in the value-based payment landscape, Gaboury indicated.
“The palliative care portion of the [VBID] demonstration has proven to be pretty significant in some cases,” Gaboury said at the FMC conference. “But [payers] are being picky about what providers are going to provide the care and are making their own definitions of who qualifies for palliative care and who does not. So while palliative care is beneficial … it is also being detailed and controlled by Medicare Advantage organizations because it’s money coming out of their pocket and they get to decide what patient care looks like. It’s honestly mind blowing.”
