How to Increase Use of Palliative Care in Medicare
I wanted to call your attention to this interesting piece from Health Affairs, entitled, “How Can We Increase the Use of Palliative Care in Medicare?”. It discusses a specific model of care, the Four Seasons Hospice Model, that is currently being tested in Western North and South Carolina.
As part of the new Health Affairs Blog series highlighting serious illness and end-of-life care, this post describes a community-based, interdisciplinary palliative care model that spans care settings and is being evaluated in a Center for Medicare and Medicaid Innovation (CMMI) demonstration project. It provides some early lessons on how alternative payment models for palliative care might be developed to increase its provision in Medicare.
The model is being demonstrated by Four Seasons Compassion for Life, a nonprofit hospice and palliative care provider operating with a network of community partners in the Western regions of North and South Carolina. Supported by $9.5 million in funding from the Center for Medicare & Medicaid Innovation (CMMI), the project began in September 2014 and, by the end of its evaluation period in August 2017, approximately 5,200 Medicare patients will have enrolled in the model. Evaluation of the project will include patient outcomes and the total cost of delivering care through the model. From these results, we will propose a new payment model for palliative care that could then be tested in other locations.
Check out the whole article here to learn about this demonstration, what they’re learning from it, and what implications that could have for increasing use of palliative care going forward.
Table 1. Policy Landscape For Financing Palliative Care Services At End Of Life In Medicare
Commercial Medicare Advantage
Prescription Drug Coverage
|Financing||Trust Fund payroll tax and other sources||Premiums with deductibles and general revenue (income tax)||Commercial premiums with deductibles||General revenue (income tax) & premiums with state contributions|
|Services||Hospital, skilled nursing, long-term care, hospice||Doctor visits, lab services, durable medical equipment, therapy||Private A + B + (D) + additional benefits
• 30 percent population
• Hospice carved out
|Cost triggers||Reduce unnecessary utilization||Increase care coordination and goals of care||Unknown; unavailable claims for research||Symptom management outlay vs. curative|
|Current movement||Hospice “two-tiered” payments with service intensity last seven days||Advanced Care Planning CPT codes
Transitioned Care Management codes
Chronic Care Management PBPM
PILOT: Medicare Care Choices Model (test $400 PBPM concurrent care for hospice-eligible beneficiaries)
|Aetna Compassionate Care program for under 65 commercial
Numerous proprietary coordinated/ palliative care management programs underway
|Review of access, medication reconciliation, polypharmacy, and discontinuation issues|
|Potential bundles as APM||Hospital-based palliative care services
Post-acute care (90-180 days) prior to hospice palliative care services
|Primary care (CCM, CPC+, PCMH medical homes) additive for palliative services in PBPM
Specialty care (CCM, medical home) additive in PBPM
|Proprietary build on HCC risk score methodology||Pharmacy/drug benefit during episode transitions (90-180 days) prior to hospice|
|Implication of ACO-MSSP||Provider groups managing Total Cost of Care (Parts A, B, D) with increasing risk models and flexibility to deliver care across settings where financial control can be leveraged||Excluded from MSSP; MA program innovation increasing but not publically shared||Clustered resourcing as part of Total Cost of Care|
Abbreviations: ACO=accountable care organization; APM=alternative payment model; CCM=chronic care management; CPC+=comprehensive primary care plus; HCC=Hierarchical Condition Category; MSSP=Medicare Shared Savings Program PCMH=patient-centered medical home; PBPM=per-beneficiary per-month