Palliative Care Has Grown Without Being a Cash Cow for Providers

Interest in palliative care programs has boomed over the last 15 years, but the adoption of this type of care has taken place largely in hospitals, according to a recent report in Health Affairs. But with palliative care now much more common, further growth could accelerate in home- and community-based settings.

Palliative care—which focuses on providing relief to people with serious illness, no matter the diagnosis—is a specialty offering that often requires a team of people to provide an extra layer of support in addition to other treatment. Between 2000 to 2015, the proportion of U.S. hospitals with more than fifty beds that had palliative care programs rose from 25% to 75%, according to the report.

One organization, the non-profit Center to Advance Palliative Care (CAPC), has been at the forefront of the palliative care movement, providing the tools, training, technical assistance and metrics to help health care providers across the continuum of care develop their own sustainable programs through its regional training centers. With nine regional centers across the country, CAPC has helped organizations including both hospitals and home health care providers, and at the outset was funded through philanthropic support.


Currently, CAPC is focused more on increasing palliative care options in home- and community-based settings. Changing health care payment systems could further support this growth, according to J. Brian Cassel, a health services researcher at Virginia Commonwealth University and report author.

Palliative care is a low-revenue but high-value service, which historically is a hard sell for providers looking to increase high-revenue profit centers, the report notes. That’s why CAPC, with philanthropic backing, has had to play such a key role in palliative care expansion. But shifts to more value-based care, which incentivizes providers and payors to offer more coordinated and less costly care, might be changing the calculus.

Coming legislation could require palliative care under some payor plans. Additionally, private insurers, including Medicare Advantage providers, are seeing more value in adding palliative care, which has been found to boost health care outcomes and lower overall costs by reducing hospitalizations.


“On the community-based side… the role for subsidizing the team falls to payors or Medicare Advantage plans owned by the health system or an accountable care organization (ACO) looking to achieve cost savings overall,” Cassel told Home Health Care News. That’s a contrast with hospitals, which typically are more able to draw on their own resources to subsidize their multidisciplinary palliative care teams.

As it is now poised to become even more prevalent, Cassel notes that palliative care growth has been a success story, with dedicated clinical leaders and philanthropic support driving adoption despite obstacles posed by the traditional fee-for-service medical model.

“The growth has been pretty phenomenal,” Cassel said. “If you look back to the growth of the field, the late 80s and early 90s, no one would have predicted it would have taken off and grown as much as it has in the last 20 years, but it’s been a remarkable uptake by the American health system.”

Written by Amy Baxter

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