New Insights into Home-Based Palliative Care

The Center to Advance Palliative Care (CAPC) has long stood as an amazing resource and advocate for palliative care providers. While their work has focused more on hospital-based palliative care in the past, a recent study has turned the focus to home-based palliative care (HBPC). A link to the study can be found below. For this work, CAPC examined 83 unique HBPC programs which served over 38,000 patients. 

Encouragingly, access to HBPC was found to be high for rural residents, a typically underserved patient population. 85% of programs served rural communities, while 82% served suburban communities and 67% served urban communities. The average drive time for home visits was 41 minutes with many programs utilizing telehealth. Another strong equity metric showed 80% of HBPC patients to be white with 14.5% being Black, which is representative of the general population. 33% of patients had cancer, 19% heart disease, and 15% dementia. 31% of patients were discharged to hospice, 18% discharged off services, and 7% died on PC. This indicates that HBPC may be moving from the “pre-hospice” model that precludes many of the strongest benefits of palliative care medicine. On the administrative side, 41% of HBPC programs are operated by hospices and 34% by hospitals. The median length of stay was 123.5 days. 48% offered 24/7 availability. 82% of programs included NPs and/or PAs, 78% included physicians, 75% included social workers, 64% included RNs, 46% included chaplains, 46% included CNAs, and 14% included LPNs. 86% of HBPC programs receive fee-for-service payments as one of their top 3 funding sources, while 51% receive support from their organization, and 47% receive philanthropic support. Only 21% receive contract payments of any kind including value-based contracting, though this is increasing. 

It is incredibly vital to start benchmarking HBPC programs, especially as Congress is considering a palliative care payment demonstration pilot. With this comes a need to build powerful, sustainable programs, which can be fostered by increased engagement with contracted payment sources, such as ACOs and Medicare Advantage plans. While Acclivity can help you explore what might be possible in your unique markets, it is also important for all home-based, post-acute care providers to learn as much as possible about these payment models and take advantage of these unique, and potentially fleeting, opportunities. 

Source Material:

“Few Patients Dying on Home-Based Palliative Care Service, New Report Finds” by Liza Berger and posted on June 21, 2023, by McKnights Home Care and accessible at Few patients dying on home-based palliative care service, new report finds (mcknightshomecare.com)

“Spotlight on Home-Based Palliative Care: Insights and Recommendations from CAPC and PCQC” on CAPC.Org, updated May 23, 2023 and available for download at https://www.capc.org/documents/1100/?clickthrough_doc_id=core.cmsdocument.1100&clickthrough_req_id=AtvnQpz3T9qEPN6aeVAmsQ&clickthrough_query=spotlight%20on%20home-based%20palliative%20care