The Upsides, Downsides To Home-Based Palliative Care Programs

Though nearly ubiquitous in the hospice space, palliative care is a service line that remains largely untapped by home health providers.

When its comes to palliative care, there’s a lot of variability from an operational standpoint, Nicole DePace, director of the advanced illness management programs at NVNA and Hospice, said during a webinar hosted by the National Association for Home Care & Hospice (NAHC) and the Home Care and Hospice Financial Managers Association on Thursday.

“I think organizations define themselves by if they’re trying to be a consultative model,” she said. “Are they participating in co-management of these patients and families, who are living with serious illness, or are they assuming some sort of primary care role in providing palliative care?”

For home- and community-based palliative care providers, this variability can be an advantage.

“It provides us a big opportunity, in terms of palliative care delivery, in that each organization is able to define what services and supports they can provide in their communities and how they want to structure a home-based program,” DePace said.

However, there is also a downside.

“There are two sides of the policy coin, we have flexibility, creativity and opportunities for innovation, and on the other side, we lack the structure and policy definitions and support that our hospice counterparts have,” DePace said.

Another roadblock for some home health agencies looking to provide palliative care is that there isn’t a stable funding mechanism for reimbursement.

“This means that funding within organizations is dependent on what we get paid for through some sort of insurance mechanism, where we’re superimposing palliative care onto an existing benefit structure, whether there’s philanthropic funding, whether there’s some sort of private pay mechanism,” DePace said.

Despite these challenges, there are more conversations than ever on the future of palliative care from a public policy perspective, Davis Baird, director of government affairs for hospice at NAHC, said during the webinar.

Many of these conversations are around the question: should home-based palliative care have its own defined Centers for Medicare & Medicaid Services (CMS) benefit, or should it be woven into different elements of other existing health care policies?

“We can and should be encouraging the federal government to walk and chew gum at the same time, in the sense that we’d like to see a [palliative] home- and community-based model tested as a standalone structure,” Baird said.

Baird also stressed the importance of legislation, such as the Expanding Access to Palliative Care Act. The bill was introduced in June, and would require the Center for Medicare & Medicaid Innovation (CMMI) to create a palliative care payment model demonstration.

“We really tried to get CMMI to see that there is demand for such a model test,” he said.

Baird noted that CMS seems to be leaning towards the integration approach, where palliative care is woven into the other care delivery models versus being a standalone.