Reimbursement and regulation reigned in the news this year, but other important trends garnered attention as well.
Below are top five under-the-radar stories that, while important, didn’t make our most read this year. The topics range from unmet staff and patient needs, financial and operational headwinds and research fueling innovative care delivery approaches.
‘This Is Different’: Building a Sustainable Palliative Care Workforce
Staffing shortages plaguing the health care industry are hitting the palliative care space in uniquely challenging ways, making recruitment and retention a rocky road.
This article explored the emerging strategies in palliative care that could have promising impacts on strengthening this workforce, including education and technology initiatives.
Demand for palliative care in the United States is projected to outstrip the supply of the clinicians trained to provide it during the next decade. A main factor curbing palliative workforce growth is that most clinicians receive little to no exposure to those types of care during their training.
More medical schools, nursing schools and health care providers have collaborated in a push for change. Palliative care education programs have increasingly cropped up across the nation. A growing number of educational and academic institutions also have created partnerships with providers to create new pathways for palliative care clinical training, with many focusing on nurses, social work and pharmacy students – areas that are hurting for qualified professionals.
Meanwhile, palliative care providers have increasingly leveraged technology — not only to help train and prepare the future workforces — but also to do more with fewer staff.
Technology has played an increasingly important role in preparing the next wave of palliative professionals to understand the nuances of serious illness care delivery. Some palliative training programs have integrated AI and virtual reality to help students workshop a variety of challenging scenarios with patients and families. Students are also trained on understanding how AI technology can reduce time spent on patient documentation and help catch errors.
Providers Hit Obstacles to Scaling Palliative Care
Palliative providers steer through a range of payment and policy hurdles that stifle the ability to grow their programs. To sufficiently scale palliative care services, providers will need a more robust reimbursement system.
A swelling aging population is among the propellers driving palliative care demand. As the need for palliation grows, outcomes and experiences vastly vary – with payment often at the crux of inconsistencies in quality and care delivery approaches.
Currently, Medicare reimburses for palliative care via fee-for-service systems that do not cover the full range of interdisciplinary care. Some coverage is available through Medicare Advantage and Accountable Care Organization (ACO) relationships, but these are not available in every market.
Some stakeholders are increasingly urging for the establishment for a dedicated palliative care benefit within Medicare that includes reimbursement for the full scope of care, though some speculation has percolated as to who it would be shaped.
Palliative services can include physical, emotional and spiritual support of serious illness pain and symptom management. Assistance with medication, transitional care and advance care planning services can fall within the palliative realm. Caregiving resources and social determinants of health programs are also part of some palliative care models.
Some in the field stipulate that the variety of palliative delivery approaches can provide a wealth of supportive care options for patients and families, along with innovative opportunities in care delivery development.
But a large concern among many is that having a broad brush of palliative reimbursement and regulation can complicate efforts to create quality measures and payment models that sufficiently foster greater access. A fragmented system can allow patients to fall through the cracks and receive varied types of palliative care services that may not sufficiently address their needs.
Without more sufficient reimbursement streams, keeping up with demand will remain struggle in the palliative care space.
Earlier Palliative Care Yields Higher ROI
Palliative care programs are often viewed as financial loss leaders rather than revenue generators – mainly due to a lack of sufficient reimbursement.
The body of research pointing to the benefits of palliative care has been growing, an important lever to expanding access and awareness, as well as providing evidence that could foster change among payers and policymakers.
Some studies have analyzed quality outcomes of palliative patients across a variety of care settings to determine the impacts on pain and symptom management. Other research has focused on the cost-savings potential of palliative care when it comes to reducing emergency care services such as hospitalizations.
This year brought key pieces of research that have painted a picture around the value proposition of palliative care.
One of which was a financial metric analysis of patients that received palliative care at the Pennsylvania-based health system WellSpan, which found that the earlier they received these services, the larger the return on investment became.
Beginning in 2018, WellSpan began to test the theory that palliative care could be a revenue generator by examining financial metrics associated with its palliative care services, with a focus on cost savings.
The cost-benefit analysis of WellSpan’s palliative care programs found that, at the system level, palliative care reduced costs per patient by 6%. When it came to hospital settings, these services were associated with lower costs, by as much as 20% at one location. That hospital had the lowest time between patient admission and initiation of palliative care compared to other facilities.
The study’s results marked the difference in cost between earlier versus later receipt of services. Earlier access and quality impacts are anticipated to be common threads that researchers will continue to unravel around palliative care.
U.S. Patients Have Unequal Access to Palliative Care
A greater focus is being placed on understanding and minimizing the health disparities plaguing underserved populations nationwide. Limited service availability is among the factors driving a wedge between patients and palliative care.
Though rural populations are largely those without a sufficient supply of nearby providers, urban settings can also be palliative care deserts, research this year uncovered.
Adults in the United States with stage IV cancer were more likely to receive palliative care in both metropolitan and nonmetropolitan areas if providers were located nearby, researchers from the American Cancer Society (ACS) found. Patients are more likely to receive palliative care if they have more providers in their vicinity to choose from, the research found.
Areas that lack palliative options are often those that also lack economic resources.Individuals with cancer have less access to palliative care physicians if they dwell in socioeconomically deprived areas, as do patients in the South or those who receive care at community facilities, the ACS data showed.
The study was among a few others that rolled out this year that dig into the common barriers to care among underserved populations.
Other research efforts have focused on disparities such as access to advance care planning among Black populations, serious illness care utilization among LGBTQ+ communities, supportive care received by Asian Americans and culturally appropriate care for Native Americans.
The data come at a time of renewed focus on health equity among providers and government agencies.
The U.S. Centers for Medicare & Medicaid Services (CMS) has made health equity a key component of its payment model demonstrations in the mix. To date, programs that have health equity components include the Accountable Care Organization Realizing Equity, Access and Community Health (ACO REACH) program, a number of disease-specific models and the value-based insurance design (VBID) model demonstration.
Pediatric Palliative Care Providers Seek to Improve Parental Engagement
Children and young adults represent one of the most underserved patient populations in palliative care. Reimbursement pressures, workforce strains and poor public awareness represent pain points preventing greater utilization. Parents are also a key, but pediatric palliative care providers often face large hurdles around family engagement.
Misconceptions about palliative care proliferate among health care providers and parents alike, including the belief that these services mean a halt to life-sustaining treatments and other curative care.
Misunderstandings have impeded providers’ ability to build stronger referral streams among pediatric physicians, hospitals and health systems. Many families are also not familiar with the scope of interdisciplinary palliative care services and the variety of physical, social, emotional and spiritual needs it can address.
Additionally, families often contend with an array of competing financial, medical and practical obstacles related to managing a serious illness that can complicate a child’s health care experience.
Studies have found that providers have room to grow when it comes to family communication and engagement.
Research from earlier this month revealed that just above a quarter (27.4%) of parents had an understanding of their child’s disease. More than half of parental participants in a Hong Kong study indicated that navigating a serious illness was a main stressor.
More collaboration and coordination of supportive resources was identified by the researchers as a way to fill gaps in knowledge and care delivery. Having emotional and physical support available can positively impact patient outcomes, they indicated.
These factors are driving pediatric palliative providers to prioritize community outreach and education efforts, as well as shift their referral strategies.
Some providers are placing a greater emphasis on how respite and therapeutic services can be the most impactful for parents and caregivers, as well as siblings.