Home-based providers are seeing tangible benefits from incorporating palliative care services as part of their offerings, but adoption of palliative service lines has remained limited.
However, reimbursement and regulatory reform, as well as electronic medical record (EMR) enhancements, can accelerate broader adoption of palliative services. In the process, at-home care providers that diversify into palliative care services can differentiate themselves from their peers and improve the quality of care.
For Dr. Kurt Merkelz, chief medical officer at Compassus, the combination of home health and palliative care is a net positive for providers.
“By leveraging palliative care partnerships with your home health, first achieving outcomes in symptom management, we do well in getting patient symptoms controlled,” he said during the discussion. “It increases patient satisfaction. We provide tremendous amounts of education to caregivers. This, in turn, results in improved home health [consumer assessment of health care providers and systems] (CAHPS) scores.”
Based in Brentwood, Tennessee, Compassus provides a wide range of home-based care services, including home health care, home infusion, palliative care, hospice care and home-based high-acuity care. It has more than 270 touchpoints across 30 states. Compassus’ palliative care program operates through joint ventures.
At Contessa Health, one of the clear benefits of providing palliative care has been bi-directional referrals.
“Obviously, there are rules, regulations and compliance around sharing information about patients,” Nikki Davis, senior vice president of palliative care programs at Contessa, said at Home Health Care News’ FUTURE conference. “How do you go about that in a compliant and regulatory fashion? It’s not easy and it’s slow, but once you get there, it’s well worth it.”
Contessa provides comprehensive in-home care. The company is based in Nashville, Tennessee, and partners with 12 health systems and 30 health plans. Amedisys Inc. acquired Contessa in 2021.
For home health providers attempting to serve rural communities — which often face roadblocks to health care services — palliative care can often be a key differentiator.
“Home health patients who are mobility impaired, who live in rural locations … they have significant difficulties in reaching their primary care and specialist providers,” Merkelz said. “Palliative care can help bridge that interaction, and be another supportive layer of seeing the patient, coordinating and communicating with the specialists and the primary care doctor, and what’s taking place in real-time in the home.”
Merkelz also pointed out that there are specific health care challenges that the combination of home health and palliative care is uniquely qualified to address.
“The home health patient is not just a hip repair that needs rehabilitation,” he said. “They’re faced with their diabetes, their COPD, their heart disease, their hypertension, along with cognitive impairment. You can’t parcel out single components of their care. Chronic care management is complex. It requires coordinated efforts. Palliative care can be an incredible support in relaying information, guiding the right medications and acute care visits.”
Similarly, Dorothy Davis, president and CEO of Visiting Nurse Health System, noted that the organization’s palliative care segment has aided its efforts around chronic care management.
“What is that patient with active pain, active symptoms, that trajectory and where’s the management of a chronic disease — understanding that clinically is really important if you’re going to have a successful palliative program,” she said during the discussion.
Atlanta-based Visiting Nurse Health System provides a variety of home-based care services to over 7,000 patients across Atlanta. Its palliative care program has been around for 15 years.
Despite the clear advantages of palliative care, the industry must change in several key ways before adoption of these services becomes more common among home-based care providers.
Reimbursement reform is critical, according to Merkelz. Payments must be updated to include the array of services provided by the interdisciplinary team providing palliative services, which he said is vital to effective palliative care.
Regulatory reform and EMR enhancements will also be necessary to transform the availability of in-home palliative care.
“We need standards on what services are going to be provided,” Merkelz said. “What are the outcomes that need to be measured? We need reform under education and how we’re providing education to every stakeholder. We need EMR enhancements … We need improved documentation of what’s taking place, of goals of care, advanced care planning. We need to be able to target and track our symptom management.”
With the potential for improved health outcomes, more holistic care and increased referrals, at-home care providers can reap tangible benefits when diversifying into palliative care – but policies, payments and technology must evolve in order to foster broad adoption.
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