Today, just a fraction of community-based palliative care programs are operated by home health providers. But the Patient-Driven Groupings Model (PDGM) and a shift away from fee-for-service Medicare will likely change that moving forward.
Throughout the health care world, the term “palliative care” often carries a different meaning from one organization to the next. In its broadest sense, however, palliative care — or “comfort care” — is specialized care for individuals with serious illness.
San Diego, California-based Mission Healthcare is one of the latest home health providers to launch a palliative care offering. It did so after months of careful PDGM education and planning, CEO Paul VerHoeve told Home Health Care News.
“We’ve definitely put more energy into a lot of our acute care-related efforts,” VerHoeve said. “That partially led to why we’ve started our palliative care program. It was an offshoot of how we looked at trying to take care of our hospital-based referral sources and the needs of their patients.”
With 11 locations, Mission Healthcare is one of the biggest home health and hospice companies in Southern California. Across those two main service lines, the company cares for about 2,000 patients a day.
It launched its palliative care program about four months ago in one of its core markets with strong home health and hospice overlap. So far, a few dozen patients have gone through the program — people with complex care needs who may have otherwise been overlooked.
“We were seeing a lot of patients who were falling in between home health and hospice, but still had significant needs in the home,” VerHoeve said. “We wanted to figure out solutions to be able to make sure we could be good partners for our referral sources and that we could care for this population of patients falling into ‘no man’s land.’”
Strategically, the value of a palliative care program under PDGM comes from referrals via hospitals and other acute care facilities.
Generally, referrals from such settings — or “institutional sources” — are reimbursed at higher rates under home health care’s new Medicare payment model. That’s why many home health providers looked at ways to serve higher-acuity patients going into 2020, though the COVID-19 emergency has since changed many of those plans.
In January, 47.8% of home health referrals came from institutional sources, according to data from Strategic Healthcare Programs. In March, that figure plummeted to just 30.8%, largely due to the decline in elective surgeries.
“We spent the better part of nine months preparing for PDGM,” VerHoeve said. “Obviously, in the beginning, it’s very much trying to get yourself educated, your team educated, trying to figure out who has the good information. From there, it’s about ultimately trying to build a plan.”
On top of its palliative care program, Mission Healthcare has leaned heavily on its EMR partner during the transition to PDGM, VerHoeve said. The provider also worked hard to ensure accurate coding across its departments.
As a result of that legwork and other innovative efforts, Mission Healthcare has fared well in the new payment environment. Still, the coronavirus has made gauging true success somewhat difficult, as the company’s census and referral patterns fluctuated greatly in spring.
Mission Healthcare’s home health volumes were down 10% to 15% in March, then down about 25% compared to historical averages in April. Volume began trending upward in May, and it has continued to stabilize since.
“It’s kind of been difficult for most providers to get a clean three- or four-month period of time without a lot of disruption or noise to understand how well they’ve managed under [PDGM],” VerHoeve said.
But launching a palliative care program wasn’t just about PDGM.
It was also a way to attract the attention of managed care organizations and independent physician associations (IPAs), according to VerHoeve, who spent time at Kindred, Vitas and other post-acute care powerhouses before joining Mission Healthcare.
Typically, payers are interested in provider partners with gap-filler programs that ensure smooth transitions of care.
Mission Healthcare’s palliative care program additionally has the appeal of managing patients over time, as many program participants eventually transfer to hospice services.
“We’ve had some pretty early successes in being able to take patients that historically we wouldn’t have been able to take,” VerHoeve said. “And there are patients who have evolved into accessing other service lines within the organization. We have an opportunity to stay in touch with this patient population longer.”
Palliative care as ‘loss leader’
Mission Healthcare’s palliative care program is relatively new, but the company is pleased with early results.
“I think all the indicators are pointing in the direction that we see this as being something that we as a company are going to put some more energy behind,” VerHoeve said.
Across the industry, More home health providers would likely get into palliative care if there was a federal palliative care benefit. Currently, the simple reality is it’s tough to run a profitable palliative care line as a secondary or tertiary service.
“Palliative care is … a loss leader,” VerHoeve. “I think in most organizations, you’ve got to find creative ways to build partnerships with payers and hopefully have other business lines that can help support these programs.”
Apart from refining the budding program, Mission Healthcare has been caring for COVID-19 patients in the home. It currently cares for between 20 to 30 patients per day, mostly through in-person visits.
“We didn’t make massive investments into telehealth during this period of time,” VerHoeve said. “I think we were just trying to stay really true to our core model.”
VerHoeve expects the coronavirus to remain a challenge for the remainder of 2020.
“We made a decision very early on as a company to say yes to taking care of these patients, which we found a lot of providers were not doing,” he said. “Caring for one of these patients in the hospital setting is very, very difficult. But caring for a patient in the home environment, where there are other people and you don’t have all of the sterile techniques or equipment, is extremely challenging for a caregiver or nurse.”