Workforce growth and referral relationship development are among the most significant determinants of sustainability and scale in the palliative care space. Opportunities abound for providers with a stronghold on successful payment and retention strategies.
Having sufficient staff is key to building a palliative care program, according to Dr. Kerry Moss, palliative care medical director for Connecticut Children’s.
Slow, purposeful palliative workforce growth can set the stage for programs to deliver a wide range of interdisciplinary services that meet a variety of patient and family needs, Moss said during Hospice News’ virtual Palliative Care Outlook Summit.
“It’s moving the mark forward as it’s happening,” Moss told Hospice News during the summit. “Growing our workforce and figuring out how to take care of our workforce is going to be the success of the growth forward. Building it purposefully and slowly, and providing a sustainable product … has been the priority. Some days there are more [palliative] consults than there are providers available, meaning that we really have opportunities for ongoing growth. When we’re building it, then they come. There’s endless opportunities.”
Connecticut Children’s provides a range of 30 pediatric services, including palliative care and hospice, and has more than 40 locations in its home state, New York and Massachusetts. The health system operates Connecticut Children’s Medical Center, a nonprofit hospital with 205 patient beds located in Hartford, Connecticut.
Alongside staffing factors, palliative care growth will in part hinge on the ability for providers to expand their reach to referral sources across the health continuum, according to Moss.
Payers and providers alike have increasingly recognized the potential value proposition of palliative care when it comes to improving quality and reducing health care costs. This trend could help to fuel innovations that can better address physical, emotional and practical patient needs, Moss indicated.
Stronger, more upstream referral relationships are needed to support greater palliative care investment and utilization, she stated.
“The opportunities are to continue to move palliative care to the very first day of the [health care] conversation,” Moss said. “Think of it as palliative care being a day-one talk. Here’s the opportunity to live well while we take care of your child, and here are the goals in doing that. The universal thing that all of us [share] at some point, in some way, is that we will benefit from palliative care. We might as well invest in continuing to make it a forefront of what we do in medicine, because all of us will all enter a phase of life at some point when we will likely be able to benefit from the services we’re creating.”
Building up palliative care programs to sustainable levels takes consistent referral and community outreach efforts, according to Rory Farrand, vice president of palliative and advanced care at the National Alliance for Care at Home.
Among the most prolific barriers preventing growth include common misconceptions that conflate palliative care with hospice among other health care providers and the general public, Farrand said.
Systematic changes are needed to break down misunderstandings around palliative care, she stated. These include engaging patients in goals-of-care conversations sooner in their illness trajectories and improved clinician awareness around the nature of palliative care services, Farrand indicated.
“We need to stop comparing [palliative care] to hospice, we have to stop conflating the two,” Farrand told Hospice News during the summit. “We need to talk about what palliative care does and how it benefits patients and their families. The systematic changes really need to start with all of us being more comfortable in having the conversations around serious illness and end-of-life care. Because if we don’t have the ability to be more comfortable with it, we’re going to continue to have a lot of difficulty explaining what palliative care can do.”
Also important will be the scope of palliative reimbursement changes on the horizon that could, Farrand said. Providers with stronger palliative care payment avenues could better shape their services around the needs of seriously ill patients and their families, she explained.
Advocating at local, state and national levels will be key to laying the groundwork for improved support for palliative care, according to Farrand.
“It gets into this idea that if more people demand it, then we’re going to see more programs that offer it and changes to reimbursement,” Farrand said. “Those systematic changes that need to happen [are] making sure that our voices are heard, whether that’s through our local representatives, at the national level, or even just within our hospital and health systems.”
