Tracking Patients in Community-Based Palliative Care through the Centers for Medicare &amp; Medicaid Services Healthcare Innovation Project

Bull, Janet; Kamal, Arif H.; Harker, Matthew; Bonsignore, Lindsay; Morris, John; Massie, Lisa; Bhullar, Parampal Singh; Hendrix, Mark; Bennett, Deeana; Taylor, Don

doi:10.1089/jpm.2017.0080

Cited by 8 publications

(5 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Previously viewed as synonymous only with end-oflife care, palliative care has moved upstream and is increasingly integrated from time of diagnosis throughout the course of serious illness. 2 The field has experienced considerable growth in the number of consultation teams, 3 outpatient clinics, 4 community-based palliative care models, 5 and medical specialty societies that recommend specialty palliative care involvement. 6 Second, the number of patients with serious illness who are eligible for palliative care services is expected to grow considerably over the next few decades as a result of the rapid growth of the aged population, better understanding of which patients are eligible for palliative care, 7 increasing awareness of the value of specialty palliative care, 8 and evolving palliative care consultation triggers and patient identification tools.…”

mentioning

confidence: 99%

Policy Changes Key To Promoting Sustainability And Growth Of The Specialty Palliative Care Workforce

et al. 2019

Self Cite

View full text Add to dashboard Cite

Specialized palliative care teams improve outcomes for the steadily growing population of people living with serious illness. However, few studies have examined whether the specialty palliative care workforce can meet the growing demand for its services. We used 2018 clinician survey data to model risk factors associated with palliative care clinicians leaving the field early, and we then projected physician numbers from 2019 to 2059 under four scenarios. Our modeling revealed an impending "workforce valley," with declining physician numbers that will not recover to the current level until 2045, absent policy change. However, sustained growth in the number of fellowship positions over ten years could reverse the worsening workforce shortage. There is an immediate need for policies that support high-value, team-based palliative care through expansion in all segments of the specialty palliative care workforce, combined with payment reform to encourage the deployment of sustainable teams.

show abstract

mentioning

confidence: 99%

Policy Changes Key To Promoting Sustainability And Growth Of The Specialty Palliative Care Workforce

et al. 2019

Self Cite

View full text Add to dashboard Cite

show abstract

“…As previously described, the intervention involves 1) a lead palliative care provider organization (Four Seasons); 2) motivated partner organizations that span settings, in which local patients receive care (hospitals, facilities, and clinics); 3) workforce development, focused on nonphysician providers; 4) clinician education conducted through the palliative care immersion course and continued mentoring; 5) interdisciplinary teamwork through interprofessional practice collaboration; and 6) quality assessment/quality improvement. 7,8…”

Section: Methodsmentioning

confidence: 99%

“…The care team served patients in both inpatient and outpatient settings, (specifically hospital, facility, home, and clinic settings) while also following up patients through care transitions between these settings. 8 This study describes the patients who were enrolled in the Four Seasons demonstration cohort and provides preliminary estimates for the model's impact on end-of-life (EOL) care utilization and Medicarefinanced costs. These results illuminate both the challenge that the model poses to the application of nonexperimental inference methods and the challenges to defining eligibility and constructing a payment model for a palliative care benefit in the Medicare program.…”

Section: Introductionmentioning

confidence: 99%

Paying for Palliative Care in Medicare: Evidence From the Four Seasons/Duke CMMI Demonstration

Taylor

Kaufman

Olson

et al. 2019

Journal of Pain and Symptom Management

Self Cite

View full text Add to dashboard Cite

Context. Palliative care improves patient and family outcomes and may reduce the cost of care, but this service is underutilized among Medicare beneficiaries.Objectives. To describe enrollment patterns and outcomes associated with the Center for Medicare and Medicaid Innovation expansion of a multisetting community palliative care program in North and South Carolina.Methods. This observational study characterizes the Center for Medicare and Medicaid Innovation cohort's care and cost trajectories after enrollment. Program participants were age-eligible Medicare fee-for-service beneficiaries living in Western North Carolina and South Carolina who enrolled in a palliative care program from September 1, 2014, to August 31, 2017. End-of-life costs were compared between enrolled and nonenrolled decedents. Program administrative data and 100% Medicare claims data were used.Results. A total of 5243 Medicare beneficiaries enrolled in the program from community (19%), facility (21%), small hospital (27%), or large hospital (33%) settings. Changes in Medicare expenditures in the 30 days after enrollment varied by setting. Adjusted odds of hospice use were 60% higher (OR ¼ 1.60; CI ¼ 1.47, 1.75) for enrolled decedents relative to nonenrolled decedents. Participants discharged to hospice vs. participants not had 17% (OR ¼ 0.83 CI ¼ 0.72, 0.94) lower costs. Among enrolled decedents those enrolled for at least 30 days vs. <30 days had 42% (OR ¼ 0.58, CI ¼ 0.49, 0.69) lower costs in the last 30 days of life.Conclusions. Expansion of community palliative care programs into multiple enrollment settings is feasible. It may improve hospice utilization among enrollees. Heterogeneous program participation by program setting pose challenges to a standardizing reimbursement policy.

show abstract

“…[7][8][9][10][11][12][13][14] In the absence of federally mandated reimbursement, an interdisciplinary CBPC program can establish a direct partnership with payers and demonstrate the positive fiscal impact of palliative care services. [15][16][17][18][19] For insurance payers, decreased hospital utilization results in avoided or reduced expenditures as less expensive community-based services are provided instead. [20][21][22][23] Setting Arizona Palliative Home Care (AZPHC) program is a free standing CBPB serving 3300 patients annually with an average daily census of 570.…”

Section: Introductionmentioning

confidence: 99%

Avoided Hospitalization Criteria: Validating the Impact of a Community-Based Palliative Care Program

Paramanandam

Volk-Craft

Brueckner

et al. 2020

Palliative Medicine Reports

View full text Add to dashboard Cite

Objective: This report describes the experiences of a community-based palliative care (CBPC) program's efforts to understand the patterns of hospital utilization, specifically utilization reduction experienced by admitted patients. Efforts to quantify and describe an avoided hospitalization and opportunities to use these data to strengthen partnerships with local insurance payers to assure sustainability of the CBPC will be discussed. Background: Patients with serious chronic illness experience emergency room care and hospitalizations with increasing frequency as their health deteriorates. CBPC programs are well positioned to decrease hospital utilization by early involvement and improved care management. Methods: Arizona Palliative Home Care (AZPHC) program is a free standing CBPC in Maricopa County, Arizona, serving 3300 patients annually. An interdisciplinary team was formed within the CBPC to facilitate the identification of avoided hospital events and communicate these data to community partners in an effective and consistent manner. The processes developed by this team are described. Results: AZPHC has enhanced its hospitalization avoidance strategies by communicating the rate of hospitalization avoidance events in a consistent and strategic manner. Providing instances of avoided hospitalizations with accompanying patient narratives to payers has enabled AZPHC to demonstrate the impact the CBPC has on improving quality of care and reducing overall costs. Discussion: CBPC programs require payment for sustainability; therefore, partnerships with local insurance payers are essential. Presenting data that validate the impact of a program from a clinical and financial perspective will advance the growth of payer-CBPC provider relationships and secure a future for funded CBPC programs.

show abstract

Tracking Patients in Community-Based Palliative Care through the Centers for Medicare & Medicaid Services Healthcare Innovation Project

Abstract: CBPC leads to the highest percentage of hospice transitions coming from the home/clinic setting. Differences between small and large hospitals demonstrate a different patient population with higher transitions to hospice and lower palliative care deaths in smaller hospitals.

Cited by 8 publications

References 18 publications

Policy Changes Key To Promoting Sustainability And Growth Of The Specialty Palliative Care Workforce

Policy Changes Key To Promoting Sustainability And Growth Of The Specialty Palliative Care Workforce

Paying for Palliative Care in Medicare: Evidence From the Four Seasons/Duke CMMI Demonstration

Avoided Hospitalization Criteria: Validating the Impact of a Community-Based Palliative Care Program

Contact Info

Product

Resources

About