Providers face barriers to expanding palliative care

Progress in increasing access to quality palliative care has been hampered by barriers in policy, payment, and common misperceptions among patients and providers.

Hospice providers can help patients and families at different points in their health care journey, but the fragmentation of the nation’s health care system has led to widespread access problems, according to Jon Broyles, CEO of the Coalition to Transform Advanced Care (C-TAC). .

It can be difficult to gather the right resources, and that’s [partly] with systematic failures in public policy, Broyles said at the C-TACCenter to Advance Palliative Care (CAPC) Leadership Summit. Palliative care is almost becoming the standard that we have to think about with a focus on the patient, the caregiver, the interdisciplinary teams, the needs of the community and all those things that are great foundations to build on.

Slow progress toward greater awareness

As palliative care policies take shape, they should include standardized mechanisms to guide providers on ways to communicate the nature of their services more clearly and consistently, according to Allison Silvers, healthcare transformation manager. at PACE.

Misconceptions around palliative care often involve healthcare providers, patients, and families confusing these services with palliative care. Clearing up these misunderstandings through more standardized communication guidelines could be a path to clarity and better awareness, Silvers said.

This lets patients, families and other clinicians know there is support throughout the process, Silvers told Palliative Care News at the summit. All of that language needs to change and needs to be a big part of what people need to focus on. There is a high tolerance for inappropriate language, which would be great if our policies were more policed ​​in some way.

Changes in palliative care delivery have been slow, but important, according to Brynn Bowman, CEO of PACE. According to Bowman, one of the keys to improving palliative support is increasing awareness among clinical teams across the continuum of care.

It is important for clinicians to better understand that palliative care is not about end of life or palliative care. It’s critical, as a gatekeeper for so many patients, to have doctors who understand when it’s time to seek palliative care, Bowman told Palliative Care News. It is extremely important to train many non-palliative care clinicians on how to collaborate with palliative care teams, how they can be helpful, and what types of services your patients will receive.

Reimbursement key to access, evolve

Expanding palliative education among healthcare professionals across the continuum is an important part of making conversations around serious illness care more automated and standardized, according to Dr. Andy Esch, a Florida-based palliative care specialist who is also a senior education advisor at PACE.

But to sufficiently expand hospice services, providers will need a more robust reimbursement system, Esch said. One concern is that as demand for palliative care increases, providers’ approaches vary too widely, complicating efforts to create quality measures, payment models and foster more great awareness, he said.

Currently, Medicare reimburses palliative care through fee-for-service systems that do not cover all interdisciplinary care. Some coverage is available through Medicare Advantage and Accountable Care Organization (ACO) relationships, but this is not available in all markets. As a result, many patients fall through the cracks.

Esch called for the creation of a dedicated palliative care benefit within Medicare that includes reimbursement for all care.

My concern for the field is sort of a part of this innovation and doing what you can with the resources you have has given way to enough concerns about the devaluation of the non-billable hospice provider due to the forces of the market, Esch told Palliative Care. News at the C-TAC-CAPC summit. I think many health systems hire people who can generate hospice visits when it’s actually the interprofessional team approach that provides the best care possible. A single provider on a team cannot do this job, you need different members at different times, this approach is essential to truly meet the needs of patients and families. I hope we continue to emphasize the importance of this.