Though relatively few home health agencies provide palliative care, those providers and their patients can benefit from more integration of those services.
Currently, the palliative care space is dominated by hospices and health systems. Only 7% of community-based palliative care programs are operated by home health organizations, compared to about 50% for hospices, according to 2019 data from the Center to Advance Palliative Care.
However, this can and should change, according to Rory Farrand, vice president of palliative and advanced care at the National Hospice and Palliative Care Organization (NHPCO).
“Home health is actually a really natural fit for palliative care providers, especially skilled services that are delivered in the home. They obviously have to continue to demonstrate improvement to continue getting payment for those patients,” Farrand said at the Home Health Care News FUTURE conference. “But at some point, they either plateau, or maybe they actually don’t improve. So they end up getting discharged from their services. They may be frail; they may be sick; they may have a bunch of symptoms, and palliative care actually can fill that gap between home health and hospice.”
Challenges do exist when it comes to developing palliative care programs, according to Farrand. The biggest are limited pathways to reimbursement, staffing, misconceptions about palliative services and widespread variations among care models.
Currently Medicare reimburses for palliative care physician and licensed independent practitioner services through fee-for-service payment programs that do not sufficiently cover the full range of interdisciplinary care.
The U.S. Centers for Medicare & Medicaid Services (CMS) also allows Medicare Advantage plans to cover palliative care as a supplemental benefit. A rising number of providers are also partnering with Accountable Care Organizations (ACOs) or other entities that operate within risk-based payment models. Some states are also working palliative care into their Medicaid programs as a means to improve outcomes and reduce costs.
“The hospice benefit is well known and well understood, and palliative care has been kind of the Wild West when you think about it from a sort of overall perspective of the landscape,” Farrand said. “On the one hand, it’s really frustrating because if you’ve seen one palliative care program, you’ve seen one palliative care. On the other hand, it’s actually really exciting, because you can really be innovative and distinct and unique in the space because you could be doing a bunch of different things.”
One organization that has been working to integrate home health and palliative care is Tyler, Texas-based Choice Health at Home.
Choice came on the scene in 2008 as a rehabilitation services provider. The company entered the home health space in 2012 and moved into hospice in 2018. In the intervening years, the private equity-based company’s footprint has expanded through acquisitions and organic growth across several southwestern states.
For the past few years, Choice has been training its home health clinicians about the areas in which home health and palliative care intersect, as well as taking steps to bring those business lines closer together and enhance coordination between them.
To further this goal, the company also partners with a number of physician groups with palliative care backgrounds, according to Trina Lanier, COO of Choice and co-founder of its hospice and home health service segment.
“We coordinate care with physicians who manage this through the [Medicare] physician fee schedule, and what our company has found is that collaborating care with these folks brings more quality of life to the patient,” Lanier said at FUTURE. “Those individuals get to spend more time in the home with those patients than we get to as home health clinicians. And because we have a hospice service line, we collaborate care with those physicians and palliative physician groups to get the patient to the right level of service at the right time.”