The National Partnership for Healthcare and Hospice Innovation (NPHI) has teamed up with the Coalition to Transform Advance Care (C-TAC) to work on building a federal fee-for-service, community-based palliative care model that would provide broader access and earlier support for patients across the United States.
Research has shown benefits for patients and families when they are able to receive palliative care early on, after the diagnosis of a serious illness. But many patients in the United States do not receive palliative care until they have reached a crisis point, Tom Koutsoumpas founder and CEO of NPHI told Palliative Care News.
“Today, many patients only receive these services very late,” said Koutsoumpas. “Most often after entering hospice, despite the fact that earlier palliative care can improve quality of life, better support caregivers, reduce unnecessary hospitalizations, and help people remain at home longer with their loved ones.”
A model that supports providing services earlier would be a direct benefit to patients but it would also support the work of providers who Koutsoumpas said have been providing community-based palliative care services for years without a sustainable reimbursement pathway.
“There are a wide range of Medicare Part B billing codes utilized by providers delivering community-based palliative care services,” he said. “However, many of the service codes are reimbursed at rates that do not adequately reflect the time, complexity and resources required to provide high-quality care.”
Many community-based palliative care providers, who often travel to deliver care to patients, commonly operate despite significant financial losses, said Kotsoumpas. And maintaining in-home palliative care programs can be particularly challenging for rural communities who don’t have large medical organizations to subsidize services. Yet, Koutsoumpas believes many carry on because the benefits of community-based palliative care outweigh the economic burdens.
“Providers continue to sustain these programs because of the demonstrated benefits of delivering supportive care upstream of hospice, including improved quality of life, enhanced care coordination, and meaningful reductions in overall health care spending,” Koutsoumpas said.
In setting out to develop this model, NPHI and C-TAC are focusing on a longitudinal, community-based approach that incorporates palliative care earlier across multiple care settings.
According to Koutsoumpas, the model’s success will be rooted in the following essential elements:
- Successful identification of patients who will benefit from palliative care programs early in their serious illness treatment.
- A tiered interdisciplinary care team structure with care coordination and case management serving as the operational backbone.
- Support to multi-site care delivery — including in the home, clinic, long-term care settings, and through telehealth — to help reduce barriers to access, particularly in rural and underserved communities.
- 24/7 providers capable of meeting the urgent and symptom needs typical for seriously ill patients.
One of the major components of developing this model will come down to creating a standardized framework for collecting data for identifying eligible patients and measuring outcomes.
“Historically, one of the greatest challenges in advancing community-based palliative care has been the inability to consistently identify the clinically appropriate population for these services,” said Koutsoumpas. “As a result, there is a significant variability in the outcomes research regarding the value of community-based palliative care — including its impact on quality outcomes, patient and caregiver experience, utilization, and total cost of care.”
NPHI and C-TAC are working with Healthsperien, a policy and health care consulting firm, in an effort to fill the gaps that have long persisted around collecting and employing palliative care data. Additionally, the NPHI and C-TAC share the goal of updating Medicare reimbursement fee schedules to align with the true cost of providing services for patients with serious illnesses.
“The model would establish a more rigorous approach to quantifying the value of palliative care services through measurement of quality, utilization, and cost outcomes,” Koutsoumpas said. “Together, this scalable data infrastructure would generate the evidence needed to support sustainable payment models and broader adoption of community-based palliative care.”
Koutsoumpas said he believes the model, if implemented successfully, has the potential to create fundamental changes in the way serious illness care is provided in the United States. He said payers and providers would benefit from a more sustainable and predictable pathway for delivering community-based care. He also believes patients and their families will gain improved access and quality of care.
“For patients and families, the impact would likely be earlier access to supportive care, improved symptom management, stronger care coordination, and a greater ability to remain in the home and community setting for longer periods of time,” Koutsoumpas said.
