Although home health providers have seen tangible benefits from incorporating palliative care services as part of their services, adoption of palliative service lines remains limited.
However, reimbursement and regulatory reform and electronic medical record (EMR) enhancements may accelerate widespread adoption of palliative services. In the process, home care providers who diversify into palliative care services can differentiate themselves from their competitors and improve the quality of care.
According to Dr. Kurt Merkerz, Chief Medical Officer at Compassus, the combination of home health and palliative care is a real plus for healthcare professionals.
“By leveraging home health and palliative care partnerships, we can first achieve success in symptom management and better control patients' symptoms,” he said during the discussion. “Patient satisfaction improves. We provide a tremendous amount of education to caregivers, which results in improved Home Health Care Consumer Assessment of Healthcare Providers and Systems (CAHPS) scores.”
Based in Brentwood, Tennessee, Compassus provides a wide range of home care services, including home health, home infusion, palliative care, hospice care, and home critical care. We have over 270 touchpoints in 30 states. Compassus' palliative care program is operated through a joint venture.
At Contessa Health, one of the clear benefits of providing palliative care is two-way referrals.
Nikki Davis, Contessa's senior vice president of palliative care programs, said at Home Healthcare News' FUTURE conference that there are “obviously rules, regulations, and compliances when it comes to sharing information about patients.” “How do we do this in a compliant and compliant way? It’s not easy and it takes time, but once we get there, it’s well worth it.”
Contessa provides comprehensive home care. The company is based in Nashville, Tennessee and works with 12 health systems and 30 health plans. Amedisys Inc. acquired Contessa in 2021.
Palliative care is often a key differentiator for home health providers seeking to serve rural areas that often face barriers to health care.
“Home health patients with mobility disabilities who live in rural areas have significant difficulty contacting their primary care or specialty care providers,” Merkerz said. “Palliative care helps bridge that interaction, providing another layer of support for seeing patients, coordinating and communicating with specialists and primary care physicians, and what's happening in real time at home.”
Merkerz also pointed out that there are certain medical challenges that can be uniquely addressed by combining home health and palliative care.
“Home health patients have more than just hip repairs that need rehabilitation,” he said. “In addition to cognitive impairment, they face diabetes, COPD, heart disease, and hypertension. The elements of care cannot be brought together. Managing chronic care is complex. It requires a coordinated effort. Palliative care can be a great support in communicating information and guiding appropriate medications and acute care visits.”
Similarly, Dorothy Davis, president and CEO of Visiting Nursing Health System, said the organization's palliative care division is supporting efforts around chronic care management.
“What is the trajectory of patients with active pain, active symptoms, and where is the management of chronic disease? It's really important to understand that clinically in order to have a successful palliative program,” she said during the discussion.
Atlanta-based Visiting Nurse Health System provides a variety of home care services to more than 7,000 patients throughout Atlanta. The company's palliative care program has been in place for 15 years.
Despite the clear benefits of palliative care, the industry must change in several important ways before adoption of these services becomes more common among home care providers.
Merkerz says reimbursement reform is important. She said payments should be updated to include a range of services provided by multidisciplinary teams delivering palliative services, which is essential for effective palliative care.
Changing the availability of home palliative care also requires regulatory reform and strengthening of the EMR.
“We need standards for what services are provided,” Merkertz said. “What outcomes do we need to measure? We need reforms in education and ways to provide education to all stakeholders. We need stronger EMRs…We need better documentation of what's going on, goals of care, advanced care plans. We need to be able to target and track symptom management.”
Home care providers can reap tangible benefits by diversifying into palliative care due to the potential for improved health outcomes, more holistic care, and increased referrals, but policies, payments, and technology will need to evolve to foster widespread adoption.
