PC’s Opportunity in Today’s Changing Payment Landscape

Topic: Payment Models

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Introduction: The methods that Medicare, Medicaid and private payers use to reimburse providers for care are rapidly changing toward value-based purchasing (VBP) arrangements. Most VBP arrangements include some form of quality and cost tracking and reporting, linking performance on quality measures and resource use directly to provider payment.

Methods: Our research developed a comprehensive picture of current and proposed quality measurement impacting payment for physicians, medical homes, hospitals, nursing homes, home health agencies, accountable care organizations, cancer centers, and dialysis centers, as well as commercial and Medicare Advantage plans.  From these, we identified the measures that palliative care has been shown to improve, based on literature review.

Findings: Palliative care positively impacts several cross-cutting measures used to evaluate health plans and providers participating in VBP arrangements.  Some of the measures that are used consistently across many of the VBP arrangements are hospital re-admissions, emergency department visits, and depression screening and management, all of which have been shown to improve when palliative care is delivered when compared to usual care. 

In addition to these measures, we found another opportunity for palliative care to impact Medicare Advantage Plans and providers: the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. The CAHPS survey measures patient experience of care via surveys provided to patients who received care in hospitals, accountable care organizations, patient-centered medical homes, cancer centers, dialysis centers, home health agencies, and nursing homes, and is also used to evaluate patients’ experience with their health plan. Questions on CAHPS surveys include topics such as communication with doctors, pain management, and shared decision-making—all of which palliative care providers score highly on.

Conclusions: There are numerous opportunities for palliative care to improve an organization's performance scores. Their ubiquitous presence makes a strong argument for the integration of palliative care teams in all the settings, and suggests that palliative care integration can be financially beneficial as well.  Additional research comparing financial performance under VBP arrangements for entities with palliative care integration to entities without is needed to confirm the potential benefits that we have found.

Author

  • Sara Mullery
  • Center to Advance Palliative Care
  • 55 W 125th Street, Suite 1302
  • New York, NY 10027
  • 212-201-2683

Co-authors

  • Allison Silvers, MBA
  • Sara Mullery
  • Stacie Sinclair, MPP

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