The future of palliative care payment is reaching an uncertain, but potentially promising time in the Medicare landscape. Trends that have taken shape in the value-based insurance design (VBID) demonstration and other payment models may be among the driving forces.
Though unlikely to take shape anytime soon, the potential for a palliative care carve-out in Medicare has been building in recent years, according to Rory Farrand, vice president of palliative and advanced care at the National Alliance for Care at Home.
Palliative care models have been gaining traction in terms of demonstrating cost savings and improved quality for several years running, Farrand said. But palliative providers have long-faced a challenging reimbursement trajectory in supporting their sustainability, she said during Hospice News’ virtual Palliative Care Outlook Summit.
“I don’t necessarily think that [a palliative carve-out] is going to happen anytime in the near future. That does not mean we have not stopped advocating for it as one of our biggest policy ‘tent poles,’” Farrand told Palliative Care News during the summit. “The Alliance has been looking at additional opportunities to provide sustainable reimbursement for palliative care, whether that is through concurrent care approaches or something like a Medicare Care Choices 2.0 Model. Those would be very, very beneficial for the population at large.”
Positive outcomes yielded by the Medicare Care Choices Model (MCCM) could be helping to build the case for a Medicare palliative care carve-out, Farrand indicated. The model pointed to the benefits of allowing patients to receive palliative and hospice care concurrently with curative care, which was found to reduce health care costs and improve quality.
Launched in 2016, the MCCM model was designed to curb costs, improve quality and family satisfaction, and keep patients in their homes. The U.S. Centers for Medicare & Medicaid Services’ (CMS) final report found that the MCCM model hit each of these targets, extending the payment period’s sunset until 2021, initially slated to complete in 2020.
The model’s 7,263 enrollees were Medicare fee-for-service beneficiaries with a six-month terminal prognosis due to cancer, congestive heart failure, chronic obstructive pulmonary disease, or HIV/AIDS. The model reduced Medicare expenditures by $7,604 per enrollee, a roughly 13% reduction compared to a control group. Hospital admissions dropped 26% and emergency department visits fell by 12%, CMS reported.
Additionally gaining momentum are questions around palliative care’s potential in the realm of Medicare value-based payment in a post-VBID era. Launched in 2021, the VBID model included a carve-in designed to test coverage of hospice care through Medicare Advantage, as well as coverage of palliative and transitional care. Initially set to sunset with the VBID’s expiration in 2030, CMS ended the hospice carve-in late last year, citing “operational challenges” related to the hospice component that limited or decreased participation.
The post-hospice carve-in landscape left lingering questions around the potential for a widening scope of palliative value-based reimbursement.
Payment models like MCCM and VBID may help to paint a broader picture around palliative care’s value proposition in more ways than one, Farrand indicated. Palliative care providers may hold powerful leverage to create meaningful change through data on their patient and family outcomes, she said.
The ability to demonstrate quality improvement and cost savings can be important points to highlight when advocating for stronger reimbursement pathways to payers and local health and state representatives, Farrand added.
Advocacy can play an important role in shaping future palliative payment trends, according to Dr. Kerry Moss, palliative care medical director for Connecticut Children’s. Connecticut Children’s provides a range of 30 pediatric services, including hospice, and has more than 40 locations in its home state, New York and Massachusetts.
Palliative care providers fight an uphill battle in finding sustainable payment for the services that they provide to seriously ill patients and their families, according to Moss. Communicating the systemic issues that reimbursement challenges can create for providers and patients alike may help illuminate to policymakers the important need for change and pave the way for collaborative solutions, she said.
“Telling your story or the story of your patient is a really valuable tool [and] we may think we [might] not get anywhere with that call,” Moss told Palliative Care News during the virtual summit. “But we’re seeing those calls come into action. I don’t know what the landscape will look like moving forward in terms of reimbursement. It is hard to predict, but I think we continue to partner with any organization that we can that supports the work we’re doing and thinking about ways to support the families in the most financially conscious, but rightful way is an ongoing challenge.”
