Providers Leverage Efficiency to Boost Palliative Care ROI

Palliative care providers are seeking ways to improve efficiency as costs rise and the limited avenues for reimbursement remain unchanged.

Payers, including Medicare, like to see providers reduce the costs of care. Likewise, improving efficiency allows providers themselves to receive a stronger return on investment considering the lack of a robust payment model for interdisciplinary, community-based palliative care.

Looking ahead to greater reliance on value-based payment models, this approach may become even more critical, according to Igal Ladabaum, co-founder and CEO of Hospi Corp, the medical supply company that developed the Macy Catheter for rapid administration of medication and fluids.

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“As we’re looking to value-based care, ultimately, everyone is tasked with providing improved outcomes and in doing so at a reduced price point,” Ladabaum told Hospice News. “If you’re able to truncate the number of nursing hours it takes to manage a complex symptom management visit, then the agency saves money; the patient is comfortable, and quality improves.”

Historically, the U.S. Centers for Medicare & Medicaid Services (CMS) has reimbursed palliative care through a fee-for-service model that only covers physician and licensed independent practitioner services, rather than the full range of interdisciplinary care.

In recent years, the agency has allowed for some value-based reimbursement through Medicare Advantage supplemental benefits and some Accountable Care Organization (ACO) arrangements. The Center for Medicare & Medicaid Innovation has also included palliative care elements within the value-based insurance design model (VBID) demonstration.

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Developing relationships with a variety of payment sources is an important strategy when it comes to making your palliative care program financially sustainable, according to Kerry Hamilton, chief strategy officer for Ohio’s Hospice.

“Having multiple reimbursement opportunities, and having our palliative care team engaged in different models — where it’s not only the Medicare Part B reimbursement that covers their salary — allows us to be flexible so that we can optimize their time, efficiency, and effectiveness across the spectrum,” Hamilton told Hospice News.

In addition to traditional Medicare, Ohio’s Hospice has several contractual population health management arrangements.

Ohio’s Hospice is a statewide alliance of nonprofit providers established in 2013 that collaborate on back office functions and expenses and leverage their collective size in negotiations with vendors, payers and referral sources. The collaborative began with three hospice members and now includes 11 organizations.

The organization currently is a direct contracting entity, but as of next year will transition to a Medicare Shared Savings Program (MSSP) Accountable Care Organization (ACO). Ohio’s Hospice also recently joined CVS Health Corporation (NYSE: CVS) subsidiary Aetna’s preferred provider network for VBID.

They also work with a few payers who offer standardized reimbursement for palliative care, according to Hamilton.

The palliative care program at Wisconsin-based Unity Hospice has evolved through several iterations. It began as a way to bridge gaps in care among heart failure patients, in partnership with a local clinic that specialized in treating that condition.

Over time, Unity’s palliative care team began serving more patients in their homes, including those with other diagnoses such as chronic obstructive pulmonary disorder or advanced dementia, according to Medical Director Dr. Amy James.

The program centers around services from a nurse practitioner, a nurse, and a social worker, as well as chaplain care when needed.

When it comes to palliative care reimbursement, Unity has developed relationships with payers through its membership in the Wisconsin Hospice & Palliative Care Collaborative. Philanthropic grants provide additional financial support to the program.

“We have some relationships with providers and with payers that through our hospice collaborative have engaged with us to provide palliative care to a select group of patients, with the expectation that we can decrease their ER visits, and their readmissions and hospitalizations,” James told Hospice News. “Some of it is through a grant. We have wonderful people on our staff who have written grants to help support some of that. So it is not perfect, and it’s not all reimbursed, but you’ve got to start somewhere.”

Among the hopes that come with providing upstream services like palliative care is that it will form a more longitudinal relationship with the patient that will lead to a hospice admission when the time is right. 

This not only helps grow the census of many providers’ core hospice business but “without question” it can help ensure smoother transitions of care for the patient, according to Hamilton.

While nothing guarantees that a palliative care patient will transition to the same provider’s hospice program, offering those services can help make that more likely, Hamilton told Hospice News.

Pursuing palliative care or other upstream services represents taking a long-term view of patient outcomes as well as financial returns as the individual may stay with your organization as they move through the care continuum, according to Catherine Dehlin, senior director of clinical services for Hospi Corp.

“It really is about being proactive versus reactive in the hospice industry. You have organizations that are extremely proactive, thinking about those upstream people and seeing the long-haul effects and the outcomes,” Dehlin told Hospice News. “And then there’s the reactive; they are sort of living in the moment and can’t quite draw that picture out in their mind. They’re looking at the cost of a device or the cost of deployment and looking for that return on investment very objectively, but very narrowly.”

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