Building a Viable Palliative Care Program (Part 1)
For decades, palliative care has been an enigma. This vital service that relieves pain and suffering to greatly improve quality of life is woefully misunderstood, delivered in a zillion different ways, undervalued by many and underpaid by all.
A big challenge for providers who want to include palliative care as part of fulfilling their missions are hindered – and maybe even penalized to some degree – by the weak reimbursement stream led by CMS.
In our most recent podcast, I have an insightful chat with Mark Hendrix, president of nTakt – a company devoted to helping providers build sustainable palliative care programs. Mark’s career started outside of healthcare with decades of focusing on process improvement and business turnaround. In fact, he is trained as a Lean Six Sigma Blackbelt with over 10 years of hands-on experience applying Lean concepts in healthcare settings. If you’re unfamiliar with Six Sigma, it’s a process often used in manufacturing that applies statistics and data analysis to reduce errors and improve efficiency. The principles can translate well to healthcare, especially if providers continue to collect and curate the data necessary to measure performance and reveal areas for improvement.
Please invest 22 minutes in hearing what Mark has to say about the current state of palliative care and his hopes for the future. This episode is the first in a series because the palliative care topic is complex and Mark has a lot of helpful information to share – including insights on billing, telehealth and a sensible model to build a palliative care program.
Besides the major obstacle of poor reimbursement, the other elephant holding back palliative care is the lack of a consistent definition and standardization of the service. If you’ve seen one palliative care program, you’ve seen one palliative care program. Providers are all over the place in what they call palliative care and what it comprises. From a consult in the hospital, to clinic-based programs, to home-based programs to who-knows-what combination of services, palliative care is a moving target that makes it difficult to understand and prevents payers from providing universal support.
Making standardization a reality
Not having a standardized definition of palliative care is not for lack of trying over the years. Several organizations and states have undertaken admirable initiatives to fill the void and create a standard.
Last year, Center to Advance Palliative Care (CAPC) published an interesting blog post on the topic. The article summarized the frustration:
“It can take months of discussion just to come to an agreement on what home-based palliative care is – including basic things such as what services are included. And what worked for one plan/provider agreement may not work for the next one, which means starting the negotiation cycle from scratch each time.”
The blog post goes on to describe an initiative spearheaded by the Coalition for Compassionate Care of California and involving Blue Shield of California along with multiple providers. The goal was to define a Medi-Cal palliative care benefit that would yield enviable outcomes and be consistently reimbursable.
The demonstration project seemed to have all the right parts for a workable definition:
- Eligibility by general and disease-specific criteria
- Description of clinical services, care coordination and communication
- Staffing – the disciplines that must be included in a palliative care program
- Measurement of specific outcomes
- Payment model – concurrent with other services and value-based reimbursement to cover efforts of all team members
The initiative was a success: “Over 900 patients started home-based palliative care (HBPC) in the 15-month window of the demonstration project, and their average enrollment was 5.8 months … Overall, the total costs of care for HBPC recipients were reduced, compared to those persons’ own baseline costs. For example, the total costs of care for Medicaid beneficiaries decreased by 49 percent, comparing four months before HBPC to four months with HBPC.”
California has invited others to follow this model. And here’s one major frustration point – this demonstration project started in 2016 with results published in 2017. So, here we are a full six years later and we’re still having the same ol’ discussions about how to standardize palliative care.
Where do we go from here?
Various associations of home care and hospice continue to advocate for change to palliative care reimbursement at the legislative level.
I have the privilege to serve on the Palliative Care Council for the National Association of Home Care & Hospice (NAHC). A nationwide panel of wise and experienced providers and support professionals meet regularly. A current focus of the Council is to develop and submit a definition of palliative care to CMS, especially in light of their CY24 Medicare Advantage and PACE proposed rule.
If you’re a member of a national or state provider association and aren’t aware of what they’re doing to advocate for standardizing palliative care and improve reimbursement, check into their efforts. Then do what you can to support their endeavors.
Because one thing is for certain: Providers need a way to collaborate and get on the same page in defining and standardizing palliative care on a national basis. Providers also need a united front in negotiating with CMS and other payers to receive reimbursement that acknowledges the value of palliative care – which also means a collaborative effort in collecting and curating data to prove desirable outcomes, including lowering the total cost of quality care.
What part can your organization play in prompting meaningful change for palliative care? It’s a topic worthy of deep consideration.