Palliative care: A slippery slope for hospice providers?
Monday, March 18, 2019
Hospice and palliative care have traditionally been two distinct services, with the former being focused on the last six months of life. More recently, perhaps due to the aging population and shifting beliefs about end-of-life care, hospice is finally becoming more accepted.
The growing number of baby boomers with chronic conditions and the desire to improve quality of life are also contributing to increased demand for palliative care. The response by some providers has been to expand the operation of their hospice programs to accommodate palliative care services.
Medicare and Medicaid requirements have been loosening, and this is leading to patients being enrolled in "hospice" programs even when a physician has not deemed them to only have six months to live.
It is often anticipated and explained to patients and their family caregivers that the patient can be re-enrolled at the end of each six-month period. This should cause healthcare leaders to give pause and consider the unintended consequences and slippery slope of blending "palliative" with "hospice" care.
Should we expect there will be hand-offs from palliative to hospice? Yes, there certainly will need to be smooth transitions. However, these are really two different types of care — just as subacute and skilled nursing; optometry and ophthalmology; psychology and psychiatry; or even podiatry and orthopedics are different.
For each, there is a different scope of care and competencies required by caregivers. They also have different philosophies and approaches to care.
A Health Affairs article clearly defines both types of care and highlights the risks to medical plans/payers who are increasingly reimbursing for home and community based palliative care services. This includes risks to cost, quality and safety.
One potential for risk comes from existing hospice providers who expand services to accommodate this new population. Another is associated with scope creep, when new programs are designed without a clear understanding of the differences between the two populations, their needs, goals and fears.
Consider the mid-stage dementia or cancer patient who is told they are being enrolled in "hospice" care and the confusion or fears they may experience. Perhaps one might even object to seeking or accepting those services. Consider also the nurse or other provider who goes from one patient to another and the risk that they lose sight of whether the older person in front of them is in hospice (preparing for the inevitable) or palliative (working toward recovery) care.
The key comes down to support being provided along with curative treatment versus being provided to those at the end of their life. This becomes a quality of care and safety issue for very sick patients and healthcare leaders.
The question becomes: how do we ensure that each different type of patient gets the care they need? In addition, it also presents risks to the goal of reducing the total cost of care and moving patients out of the hospital more quickly.
The article includes recommendations for medical plans and payers to avoid unintended consequences.
By extension, it is important that hospice providers assess the distinctions between their palliative and hospice services. Home health agencies and other community providers should also begin to recognize the opportunity for new revenue streams that may complement their existing programs or services.
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