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A wide variety of palliative care services have cropped up nationwide in recent years, but not all have remained viable.
The forces driving some community-based palliative programs to shutter are two-pronged, related to financial and operational sustainability, according to Renee McInnes, CEO of NVNA & Hospice. Reimbursement and staffing challenges are the most significant factors.
“It’s really the funding. There’s many that are cutting their palliative care programs just because the reimbursement for palliative care is still largely fee-for-service and it doesn’t cover the direct costs,” McInnes told Palliative Care News. “It’s very, very costly and you can lose millions of dollars a year to provide this care because reimbursement doesn’t appropriately cover the cost of salaries and the education in palliative care. Another thing is having qualified staff that are certified, educated and understand what palliative care means and how to manage these patients with acute or chronic illnesses.”
NVNA & Hospice provides home health, hospice and community-based palliative services. Its palliative program has an average daily census of roughly 145 patients. The Massachusetts-based provider has a service region of roughly 27 towns along the state’s southern coast, including those in the greater Boston area. The region has seen more health care providers scale back on either launching or growing their community-based palliative services, or cutting them altogether, according to McInness.
Shallow palliative reimbursement is at the crux of the sustainability issues, according to McInnes.
“Both Medicare and managed care don’t reimburse appropriately to cover the cost of salaries and education in palliative care,” McInnes said. “The time it takes with palliative care visits can be much longer than the typical home health visit. So productivity cannot be as robust for some of the social work, chaplain or nurse visits. Organizations typically have to find a way to fill that financial gap. Typically that’s with a lot of fundraising for palliative care. But palliative care is really the way of the future to really meet people’s goals of care, keep them out of the hospital and give them a good quality of life.”
Fewer companies have plans to launch a new program this year than in the recent past. Roughly 16% of 143 provider respondents signaled their intention to start palliative care programs this year in the Hospice News’ 2024 Outlook Survey, conducted with Homecare Homebase. This is down from 56% of respondents in 2023.
However, questions over sustainability are increasingly garnering attention at the payment and policy development level, according to Center to Advance Palliative Care (CAPC) CEO Brynn Bowman.
More disease-specific payment model demonstrations are integrating palliative care concepts, Bowman stated. These include programs like the Guiding an Improved Dementia Experience (GUIDE) model unveiled last year by the Center for Medicare & Medicaid Innovation (CMMI).
Though not a palliative care-specific payment model, those providers may be well-suited to deliver the interdisciplinary services included in the GUIDE model, which features a standardized set of services based on a person-centered care plan.
“We’re talking about very sick patients with very complex needs who are at a higher risk for suffering and hospitalization,” Bowman said at the Hospice News Palliative Care Conference. “They will take an adequate and reliable system for a standard set of services to avoid those outcomes. It comes back to money. We see places where the needs that palliative care intends to address are infiltrating into models that health care gets paid for, it just hasn’t so much translated into a standardized model of specialty palliative care for those patients who really need that service.”