Palliative care providers have explored diverse routes to improve quality and access to their services in 2024.
Below are five under-the-radar stories that, while important, didn’t make our most read this year. The topics spanned evolving reimbursement trends, innovative care delivery partnerships and research examining the biggest barriers among undeserved populations.
Palliative Care ‘Ahead of the Game’ in Approaches to Treating Rare Diseases
Patients with rare disease face myriad challenges when it comes to navigating the complexities of their disease trajectories. A new research project launched this fall set out to examine how access to palliative care services can help support these patients’ physical, spiritual and practical needs.
The Center for Innovation & Value Research recently launched the second phase of its Rare Disease Project in October. The initiative is aimed at examining the diverse range of these illnesses and the patients impacted by them.
The project is designed to learn more about the innovative, person-centered care models that can help address common challenges that these patients and their caregivers face — including approaches that integrate palliative care services.
Having access to palliative care services sooner in a rare disease trajectory could benefit patients, their families and caregivers, according to the researchers. Caregivers supporting a loved one with a rare disease commonly report difficulties such as anxiety, stress, isolation, depression, financial strain and impaired ability to work.
The research effort comes as palliative care providers increasingly work to illustrate the value proposition of their services across the health care continuum. Palliative care providers are becoming a larger part of improving outcomes among patients with rare diseases by helping to address nonmedical needs, symptom management, care coordination, spiritual support and ensuring goal-concordant care delivery.
How Palliative Psychiatry Can Support Quality of Life, Symptom Management
Demand has swelled for greater collaboration between palliative care and psychiatric service providers among seriously ill populations with mental health conditions.
Seniors with severe mental illnesses (SMIs) face greater risks of experiencing adverse health effects as their diseases progress compared to others, providers told Palliative Care News. SMI patients with serious physical illnesses often have less access to appropriate medical care and mental health services. These patients also have more difficult and complicated health trajectories, the providers indicated.
Patients with mental health conditions are most frequently referred to palliative services when they have exhausted all other medical treatment options. However, these patients could benefit from palliative services such as goals of care conversations and advance care planning much sooner in their illness trajectories, according to providers.
Though palliative care and behavioral health collaborations can be beneficial for patients, widespread misconceptions and a fragmented health care system represent significant headwinds curbing growth.
Palliative psychiatry approaches have been gaining momentum across health systems in the United States to better support patients and their families, with collaborations also increasing in India and Canada.
What Hospice VBID means for Palliative Care
Palliative care’s future reimbursement streams may see impacts with the impending end of the hospice component of U.S. Centers for Medicare & Medicaid Services’ value-based insurance design (VBID) model.
Launched in 2017 by the Center for Medicare and Medicaid Innovation (CMMI), the VBID demonstration tested new approaches to reimbursement across a variety of health care settings. This included the addition of the hospice component in 2021, which was designed to test coverage of those services through Medicare Advantage.
CMMI extended the program through 2030, but recently announced that the hospice portion will end on December 31, 2024. CMS cited operational challenges related to the hospice component that limited and decreased participation among Medicare Advantage Organizations (MAOs) and impacted “a thorough evaluation” of the demo.
Many providers believed the inclusion of palliative care under VBID would allow for a serious illness population health management program within Medicare Advantage. Among the expectations was that palliative care providers would have the opportunity to demonstrate how their services help reduce care costs while improving quality in a risk-based reimbursement structure. The inclusion of palliative care was also designed to help ease burdensome care transitions by preventing acute hospitalizations and increasing early enrollment in hospice as appropriate.
Often called the hospice carve-in, its demise has largely been met with a sense of relief by providers as they plan new initiatives for palliative care in 2025. Initially containing promising components designed to give patients better access to palliative care, the carve-in instead became an increasing source of frustration.
Challenging this payment pathway in the VBID model was a lack of definition for the palliative care component, which led to widespread issues of consistency across the demonstration, sources told Palliative Care News.
Questions remain around palliative care’s potential in the value-based landscape without federally established standards for these services that would stipulate eligibility requirements and quality measures. The larger VBID demonstration continues until 2030 and covers services across the care continuum.
How Poor Health Literacy Can Diminish Access to Palliative Care
Researchers have increasingly sought to connect the dots among barriers that impede access to palliative care among underserved populations.
Low health literacy may impair elderly patients’ understanding of health messages and limit their ability to care for their medical problems, a Journal of the American Medical Association study found. Low health literacy may impair elderly patients’ understanding of health messages and limit their ability to care for their medical problems, a Journal of the American Medical Association study found.
The research found that low health literacy among seriously ill patients can impede access to palliative care and complicate efforts to improve health equity.
Palliative care providers have sought to address the issue through greater staff education efforts, and revamping their public outreach and marketing materials to ensure improved readability.
The research comes as health equity issues increasingly receive a spotlight and palliative care providers seek to better understand the barriers fueling disparities. Prolific health disparities have driven providers to implement various strategies to improve diversity, equity and inclusion among underserved patient populations. But some providers say the needle has to go further toward equitable access.
How Palliative Care Could Help Break the SNF-to-Hospital Cycle
Palliative care providers have increasingly leveraged their services’ ability to improve quality and generate cost savings among seriously ill patients, with more of these organizations seeking out collaborations with rehabilitation teams in skilled nursing facilities (SNF).
Some patients see a cycle between the hospital and the nursing home in their last year of life, a trend igniting greater coordination and integration between rehab and palliative care teams. Nursing homes may be incentivized to hospitalize residents eligible for both Medicare and Medicaid, according to a study in the New England Journal of Medicine. These patients can later return to the nursing home with a higher-paying Medicare benefit before transitioning back to long-term care with lower Medicaid day rates.
Integrating palliative care into rehab therapy could involve implementing measures in SNFs to help better identify high-risk patients and instill requirements for clinical coordination with palliative care providers, researchers stated in the study.
These integrated care models could allow for earlier initiation of goals-of-care conversations sooner in the disease process and help clinicians to better understand the wishes of the patients and their families, the researchers indicated.
The research highlights prolific financial issues for palliative care providers and their patients. Much of their reimbursement lives in the fee-for-service Medicare landscape, which is insufficient to support the full scope of interdisciplinary palliative care services.
Case in point, Medicare home health benefits do not adequately cover hands-on care for daily living activities. Meanwhile, Medicare SNF benefits emphasize short-term rehab stays, leaving few viable options for seriously ill patients other than spending down assets for post-acute care to eventually qualify for Medicaid.
