Financial and logistical challenges can stop the launch of a new palliative care program dead in its tracks. Demonstrating strong quality and cost-saving outcomes is a significant part of building and sustaining these services.

Patient data collection play an important role in examining an organization’s potential capacity for a palliative care service line, said Keith Everett, CEO, ProCare Hospice and founder and principal at the consulting firm TruHue LLC. But the ability to leverage quality data is challenged in the palliative care space, Everett stated.

No dedicated, federally-established reimbursement framework exists that is specific to palliative care, leaving a gap around standardized quality and regulatory measures that can be critical to establishing a new program, according to Everett.

“One of the most critical gaps in palliative care is the lack of direct patient feedback, [but] you have to start somewhere,” Everett told Palliative Care News. “Palliative care is more than just treating symptoms, it’s about improving quality of life. Advocacy for more tailored quality measures is necessary to further advance the field.”

Challenges from the get-go

ProCare’s palliative care program, ProCare Continuum, has historically focused on providing inpatient services across local hospitals. The Las Vegas-based provider is in the process of expanding with a community-based version of the program.

The ability to track quality measures played a significant role in the expansion, Everett said. But deciphering what data to collect and the methodology involved can be challenging. Having a “rich database” that measures and tracks outcomes across different care settings can be a helpful tool in assessing a need for palliative care support, Everett stated.

Even armed with quality data, supporting the launch of a palliative care program can be a heavy financial lift and come with operational complexities, according to Deena Latargia, clinical nurse consultant for SouthEast Hospice. Latargia previously served as the hospice’s executive director before retiring in 2019.

Martinez, Georgia-based SouthEast Hospice serves 11 counties statewide. The hospice provider recently considered rolling out a new palliative care program due to rising demand. The decision involved months of research, employing the help of a consultant and laying the groundwork for a palliative care business plan.

SouthEast Hospice ultimately decided not to move forward with the launch due to financial challenges, according to Latargia.

“There was a cry in the community from our health care referral partners that are really underserved,” Latargia told Palliative Care News. “But these programs can be slow to grow and gather the information needed, although there’s a huge need. The reimbursement for Medicare and Medicaid palliative care is basically break-even at best. We’ve decided to not launch a program at this time, despite there being a great need for palliative care services in our area. The reality is it would be very difficult for a small company such as ours to financially sustain a program.”

Some of the main reasons for the consideration of a new program included a growing base of referral sources requesting certain services such as advance care planning, palliative consultations and education around managed care, Latargia indicated.

Increasing recognition around palliative care’s “soft return on investment” were leading reasons that drove the consideration of a new program forward. Palliative care services have the potential to improve timely hospice referrals, care transitions and reduce aggressive and expensive treatments, Latargia stated. Demonstrating the “huge value and benefits” of palliative care could help strengthen referral relationships by easing some of the financial, operational and staffing pressures they commonly experience associated with these issues, she stated.

Costs were the biggest barrier, according to Latargia. During the consideration process, SouthEast Hospice determined that launching a new palliative care service line would incur a financial loss of $91,000 within the first year of operations if the program reached a census of 50 to 100 patients.

Insufficient resources and guidance exist to help new palliative care programs take flight, Latargia said. While some organizations have issued general palliative care playbooks, these can be very broad and lack financial guidance on details related to billing, revenue and the scope of return on investment. Smaller providers with fewer resources have minimal options and insufficient instructions on how to financially sustain a new program. The financial outlook can be bleak and costly, she stated.

More palliative payment incentives or increased fee-for-service reimbursement from Medicare are needed to move the needle toward improved support, according to Latargia.

“It’s about who is going to pay for the palliative care, the education, the support and the services,” Latargia said. “We can’t be going into this blindly. We don’t want to set ourselves up for financial challenges for our hospice to start a separate branch of business that has other effects on success.”

Demonstrating value is key

Knowing what data are important to demonstrating the value of palliative care services is key to successfully navigating a complex palliative care reimbursement landscape — particularly in the value-based arena, Everett indicated.

An organization’s electronic medical record (EMR) system can be fine-tuned to identify significant quality indicators such as advance care planning discussions and outcomes, patient and family satisfaction surveys, as well as pain and symptom management feedback. Additionally important is the ability to tie services back to avoided or reduced emergency department visits or hospitalizations, which can result in overall cost savings, Everett stated.

Movement is percolating to better support the advancement of palliative care delivery, including the ability to track and measure quality.

TruHue has developed a palliative care patient survey that addresses clinical care, communication, access, psychosocial factors and overall satisfaction. The survey will hopefully serve as a tool to “strip away the noise” and “get to the heart” of what really shapes a patient’s journey through advanced illness, Everett said.

Quality in palliative care is not static and evolves with ongoing research efforts around best practices, he stated.

“There are a couple different ways to slice up the data,” Everett said. “You can set your EMR to extract information and do this in pilot phases, where you’re managing patients and attempting to get the data. You can walk into this space already knowing what your quality performance looks like, already knowing the data collection, the outcome process, where your patient satisfaction is at.”