Legislation and Alternative Payment Models Increase Access to Palliative Care

Palliative Care

Improvements in healthcare over the last decade or two have helped to ensure that patients are living longer, which has brought attention to certain gaps that exist in the current system. One of the areas facing special scrutiny is that of palliative care, often mistaken for hospice care.

Palliative care, intended to provide symptom relief, is actually appropriate for any stage of a serious illness and can benefit patients greatly when paired with curative care. But with hospices currently being the largest providers of palliative care, patients newly diagnosed with non-terminal illnesses are often uncomfortable discussing care options with their doctors. In order to help expand services to all eligible patients, policymakers have been introducing palliative care bills focused on increasing access to information.

Current Barriers to Palliative Care Access

According to palliative medicine specialist Pippa Hawley, the word palliative was initially intended to be a more socially acceptable term but has now come to be a “euphemism for dying.” This strong negative association presents just one barrier of many to providing quality care to all eligible patients. Patients feel that if they’re not terminal, they can’t get palliative care, or it’s not appropriate to ask. Other barriers include, but are not limited to:

  • Lack of formal training for medical professionals on palliative care
  • Lack of public awareness of how palliative care can be used from the point of diagnosis throughout disease progression
  • Payment restrictions that do not cover simultaneous palliative and curative care


Legislation With an Eye for Change

Policymakers at both the state and federal levels are very aware of these barriers and have been working to remove them through legislation.

At the federal level, the Palliative Care and Hospice Education and Training Act (PCHETA) is a bill that aims to provide healthcare professionals with greater training on palliative care, expand research nationwide, and involve the HHS Agency for Healthcare Research and Quality in a campaign to increase public awareness on palliative care options.

At the state level, this year Virginia, Nebraska and Ohio have proposed or enacted legislation with common themes such as:

  • Creating an interdisciplinary council (or similar entity) that meets regularly to assess current palliative care needs and available resources in the state
  • Improving public awareness of palliative care services through information on the state’s website
  • Establishing education programs through each state’s Department of Health and Human Services (DHSS)


Continuing the Transition to Value-Based Systems of Payment

Such legislation would greatly improve physicians’ and patients’ awareness of palliative care options. At the same time, organizations such as the American Academy of Hospice and Palliative Medicine (AAHPM) and CMS’s Center for Medicare & Medicaid Innovation (CMMI) have been working on alternative payment models (APMs) that would remove one further barrier to access of care: payment for providers.

With care transitioning from fee-for-service to value-based payments, APMs are expected to comprise the majority of Medicare payments by the end of 2018, according to the Center to Advance Palliative Care (CAPC). AAHPM’s model, the Patient and Caregiver Support for Serious Illness (PACSSI), includes two tracks: one for payment incentives and the other for shared risks and savings. CMMI recently ended its evaluation period of a palliative care model this past August.

Intended to address current gaps in the Medicare system and allow greater options for patients either not eligible for or not electing hospice, these models would assist with integrating palliative care into standard care in order to ensure best results for the patients.

Palliative Care Coming of Age

Palliative care has been shown to not only improve quality of life for patients with serious illnesses, but also to reduce medical costs such as emergency room visits and hospital stays. Through healthcare professionals’ increased understanding of care options and use of APMs, palliative care could be combined with curative care to help patients lead more active lifestyles after diagnosis.

Hospice and palliative care staff leaders, administrators and strategic planning leaders will be interested to know about the status of palliative care bills and the continued development of APMs to understand the latest trends in their field as well as what they can expect in the coming year. Join home health and hospice expert Gloria A. Turner as she discusses key barriers to access of services, pertinent legislation, and opportunities to become more involved in policy and healthcare reform in a webinar with ProfEdOnDemand, Aligning Palliative Care Services in 2018: Latest Trends, Insights and Data.” Gloria will guide you through key changes for 2018, new payment methods and alternative payment models (APMs), as well as tools to determine the best palliative care program for your community.

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