US Senators Call on CMS to Boost Palliative Care Resources

A bipartisan group of nine U.S. Senators have written to U.S. Centers for Medicare and Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure, calling for a payment model demonstration designed to support greater access to palliative care.

The lawmakers urged the Center for Medicare & Medicaid Innovation (CMMI) to develop a dedicated community-based palliative care benefit, which has been a longstanding goal for providers and industry advocacy groups.

Signatories on the letter included the co-founders of the Senate Comprehensive Care Caucus, U.S. Senators Jacky Rosen (D-Nev.), John Barrasso (R-Wy.), and Deb Fischer (R-Neb.), as well as Roger Marshall (R-Kan.), Catherine Cortez-Mastro (D-Nev.), and Krysten Sinema (D-Ariz.).

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“Allowing palliative care to be provided wherever the patient is located — be it at home, at a caregiver’s home, in the hospital, in a nursing or assisted living facility, or through telemedicine — is critical for both the appropriateness and quality of care for the patient and also to ensure effective and efficient use of health care facilities and avoidance of unnecessary visits to inpatient settings,” the senators wrote.

While the availability of palliative care is improving, fewer than 5% of patients with serious illnesses who stand to benefit from palliative care actually receive it, according to a May 2019 report by the National Academy of State Health Policy.

In addition to the benefits for patients and families, home-based palliative care could reduce societal health care costs by $103 billion nationwide within two decades, the nonprofit economic research group Florida TaxWatch reported in 2019.

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Currently, Medicare reimburses for palliative care physician and licensed independent practitioner services through fee-for-service payment programs that often do not sufficiently support the full range of interdisciplinary care.

“Americans enrolled in Medicare should have the option to access integrated, interdisciplinary, patient-centered, goal-oriented care for serious illness …” Edo Banach, president & CEO of the National Hospice and Palliative Care Organization. “For more than 40 years, we have seen this type of care approach deliver high-quality care at the end of life. It’s time to bring that model earlier in the care continuum with palliative care delivered when and where the patient needs it.”

As a number of vitriolic partisan debates roil Congress, a CMMI demonstration may be the nation’s best bet at developing a dedicated benefit.

CMMI has the authority to develop and test new payment models without Congressional action. Many hospices are currently participating in other CMMI programs, including the value-based insurance design demonstration (Medicare Advantage carve-in.

Rosen, Barrasso and Fischer in 2019 co-founded the bipartisan Comprehensive Care Caucus in the Senate to advance legislation that would expand services available to the seriously ill, including palliative care.

Some members of the hospice community applauded the senators’ call for change.

“More than 35 years ago, the hospice Medicare benefit was enacted and has been instrumental in improving quality of life for patients,” said Nick Westfall, president and CEO of the Chemed (NYSE: CHEM) subsidiary VITAS Healthcare. “We stand ready to build upon this proven framework to serve more of our nation’s seriously ill patients, at home, without unnecessary, high-cost transitions, so patients and their families can focus on what really matters.”

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