Battling for Palliative Care

When I started in the hospice field over 30 years ago, we felt that all palliative care was hospice and the two concepts were pretty synonymous. That has changed – for the benefit of patients and providers alike. However, misconceptions around non-hospice palliative care persist, including among the providers of PC services themselves. Until these are addressed, the full potential of PC will not be realized. 

PC is still closely associated with hospice, perhaps especially when the PC provider is a hospice. Many PC programs center their eligibility criteria on terminal prognosis or life-limiting diseases, not all chronic conditions that call for symptom-management. Many do not set discharge criteria, seeing hospice admission as the ultimate outcome for all PC patients. Many use hospice metrics as quality criteria for PC, such as conversion to hospice and hospice length of stay. Many PC programs are staffed by clinicians who also care for hospice patients, including the on-call response. Many PC programs are developed as “hospice lite”, providing the full slate of IDT services even if those services cannot be reimbursed. If the providers themselves do not create the clear distinction between hospice and non-hospice PC, how are consumers or referral sources supposed to do so? While pre-hospice patients should definitely be part of a PC program, they should not be the totality of it. By doing so, PC providers are limiting their market, promoting misconceptions about PC, not providing clarity for their staff, and limiting their reimbursement potential.  As non-hospice PC becomes more and more integrated into the innovative value-based payment models being introduced by CMMI, which are increasingly reflected in the contracting opportunities offered by risk-bearing entities, the need to create PC programs that are distinct drivers of care is growing. Who is better positioned to be the driver of a patient’s care than those who specialize in a holistic, community-based care plan defined by the patient’s preferences? Until the providers of PC own this distinction and move PC out from behind their hospice programs, the full power of palliative care will not be realized.

Source Material:

“Breaking Down Common Palliative Care Misconceptions” by Holly Vossel posted on July 7, 2023, by Palliative Care News and accessible at https://hospicenews.com/2023/07/07/breaking-down-common-palliative-care-misconceptions