Developing a Business Case for Palliative and Community-Based Care

Palliative care is seeing rising interest and demand, but one of the biggest obstacles to providing it is determining a funding source. For now, palliative care is most often covered when providers are part of a hospital or health system. With the help of a grant-funded program from the Centers for Medicare & Medicaid Services (CMS), one provider has helped build a business case for offering palliative care and improved hospice care access.

Spectrum Health System has developed a community-based continuum of care, encompassing at-home care, geriatrics, long-term care, palliative care, hospice and rehabilitation. The system is currently underway with a grant from CMS, and is proving that real cost savings can be achieved through palliative care.

Spectrum, based in Michigan, has 34 locations, more than 2,000 employees, medical group professionals and affiliated providers, and serves more than 3,500 patients.


Hospice and palliative care development

Over the past two years, Spectrum has developed a hospice and palliative care department, in part because the health system has taken part in the Medicare Care Choices Model (MCCM). The model offers a new option for Medicare beneficiaries to receive “hospice-like support services from certain hospice providers,” according to CMS. It enables patients to also receive curative care in addition to hospice—something the regular hospice benefit does not allow.

“We were part of the first wave of [providers] across the country given this opportunity,” Dr. Simin N. Beg, division chief of Spectrum Health and Palliative Care, said during a presentation at the National Leadership Conference in Washington, D.C. last week. The conference was put on by the Visiting Nurses Associations of America (VNAA), ElevatingHome and the Alliance for Home Health Quality and Innovation.


MCCM provides Spectrum grant funding to offer palliative care to eligible patients, and CMS is studying how this access to additional services could result in improved quality, patient and family satisfaction and effects of the use of curative services. However, the model has “very strict criteria,” Beg said.

Approximately 60% to 70% of Spectrum’s referrals are not eligible for the MCMM.

“There was no wiggle room with CMS,” said Rachel Cardosa, nurse practitioner with Spectrum Health Palliative Care. “That was nonnegotiable.”

The first phase of the program began in January 2016 and will continue through 2020. Of the 501 total referrals in 2016 to 2017, only 81 were admitted to the MCMM program; 295 didn’t qualify; and 80 were admitted directly to hospice. As the continuing care department has developed, patients admitted directly to hospice have seen a longer length of stay.

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Participants in the MCCM who were treated for roughly six months were associated with significant cost savings, according to Spectrum’s case sample. The savings help prove the underlying value proposition of palliative care—even with such a restrictive set of patients.

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According to Spectrum, there is a “significant need” for additional services in this area, which treats complex, high-need patients. Proving the business case for offering palliative care in addition to other services could help provide a pathway for wider access and funding in the future.

Written by Amy Baxter

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