Palliative Care Remains ‘Wild West,’ But Home Health Providers Are Still Investing In It

Despite barriers, there’s opportunity for home health providers that are fully invested in palliative care programs to thrive.

Palliative care is both a clinical specialty and a philosophical approach to care, Rory Farrand, vice president of palliative and advanced care at the National Hospice and Palliative Care Organization (NHPCO), said last month at Home Health Care News’ FUTURE conference.

“Fundamentally, the goal of palliative care is to alleviate the stress and strain of serious illness and improve patient’s quality of life, by providing wraparound holistic care that addresses the patient’s physical, spiritual, psychosocial and emotional symptoms that go with serious illness,” she said.

The Washington, D.C.-based NHPCO is the largest membership organization for providers and health care professionals that care for people affected by serious and life-limiting illness.

Health care leaders operating in the palliative care space are often fond of the saying that, “if you’ve seen one palliative care program, you’ve seen one palliative care program.”

It’s a reference to the fact that there tends to be more variation across different palliative care programs versus the uniformity seen across some of its post-acute care counterparts.

“Palliative care has been kind of the wild, wild west from an overall perspective of the landscape,” Farrand said. “It’s actually really exciting because you can be innovative, distinct and unique in the space.”

For example, a home health provider working with a health system or Medicare Advantage (MA) plan that is struggling with readmissions could tailor their palliative intervention to focus on understanding that transition from the hospital.

“[This means] making sure that those discharge plans are understood and adhered to, that the patient’s meds are stabilized, and doing everything you can to kind of keep them safe and stable in the home in those first three days,” Farrand said.

The other side of the “wild wild west” coin is that palliative care is still seeing challenges around reimbursement.

Palliative care is not reimbursable specifically under Medicare, which means figuring out a way to make this service line financially viable can be a pain point for some providers.

Most of the time, palliative care is covered under fee-for-service arrangements, for example, under Medicare Part B.

One provider, Choice Health at Home, has found palliative care to be a vital component to its post-acute care services.

“At Choice, we talk a lot about treating the entire patient, about integrating palliative and curative care to create a more thorough approach to the most critical cases,” Trina Lanier, chief growth officer at Choice Health at Home, said at the event. “As a patient with a chronic illness is near death and dying, the palliative component increases while the curative side becomes less effective. Navigating that dichotomy is something that we try to excel at.”

Tyler, Texas-based Choice is a home health, hospice and rehabilitation services provider. The company operates in over 60 locations across Texas, Louisiana and Oklahoma.

The company partners with physician groups in order to provide palliative care.

“[With palliative care], there’s really not a pure play payer strategy for home health,” Lanier said. “Home health gets paid for a social worker going out to do a visit management with heart failure or COPD patients, like all chronic diseases. The purely palliative visit, we coordinate care with physicians, with physician groups, who manage this through the physician fee schedule. What our company has found is that collaborating care with these [clinicians] brings more quality of life to the patient.”

When thinking about setting up more home health providers for success in their palliative care efforts, Farrand urges them to look toward value-based care payment structures, such as partnering with ACOs or physician practices that are taking on risk.

“How can you help them make sure that they’re achieving the metrics they’re hoping to achieve, and negotiating payments that may have a quality bonus associated with it, so if you hit agreed upon metrics, perhaps you get a portion of shared savings?” she said.

Farrand warns that these arrangements are not always easy to implement, but can be profitable if done correctly.

“That’s where I’m seeing a lot of success — organizations that have the capabilities to navigate that value-based landscape,” she said. “That’s where the future of palliative care really is going to land.”

For Choice Health at Home, the company has found palliative care to be a factor when it comes to its growth strategy.

“Our entering into the Arizona hospice was earmarked by collaboration with a physician named Dr. Ken Pettit,” Lanier said. “He is board certified and very well respected as a palliative care physician. We’ve taken our newest specialty initiatives in care for dementia and Alzheimer’s and heavily integrated that with our end-of-life planning initiatives, so we’re moving on this, from both an organic and an M&A vantage point at this time.”

Looking ahead, Lanier believes that advocacy will be important in seeing more widespread adoption of palliative care across home health care.

“We need to become bigger advocates for palliative care,” she said. “Families suffer a lot because they see their loved ones in pain.”