Palliative Care Billing Loss Leader Myth

Palliative Care Billing Loss

Hospice and Palliative Care in the United States are now over 50 years old. Originally founded to help patients manage symptoms associated with severe illness and end-of-life, providers deliver unparalleled care for those patients who need it most. Frequently, Healthcare organizations that serve Hospice patients offer Palliative Care as an extra level of support for patients who are not yet eligible for Hospice care. In fact, approximately 35% of all Palliative Care patients eventually become eligible for Hospice care.

In 1982, with the support of Medicare funding, the Hospice care business became self-sustaining. That has not been the case for Palliative Care, which continues to struggle to find a profitable revenue model, even though the need for palliative services has nearly doubled in the last decade. Constrained budgets force Palliative Care providers to function with a limited staff and work with insufficient tools to chart, schedule and monitor patients effectively. These tools and the processes they enable are perceived as critical by providers, and their scarcity creates a myth that Palliative Care is destined to be a loss leader in the operations of end-of-life care. Busting this myth would constitute a game-changer for patients and the providers who serve them.

Recent Changes

In recent years, several significant events are reshaping this Palliative Care landscape in a positive way:

  • Medicare Billing–CMS recently approved Advanced Care Planning and Non-Face-To-Face billing codes. These codes fund two central elements of the Palliative Care model and potentially double revenue per visit. For the first time in the history of Palliative Care, a provider can bill more than their salary. Although this is a financial game-changer, many providers are still not fully utilizing these codes.
  • Alternative Payment Models–Four Seasons Compassion for Life, for example, recently received a CMMI grant to recommend alternative payment models for Palliative Care. The results, however, are still being finalized their efforts are taking center stage in a movement to make palliative care independently sustainable business. Regardless of the outcome, the knowledge learned from this grant will be instrumental in defining a sustainable Palliative Care model.
  • Education–Attendance at the CAPC Annual Seminar continues to grow each year. CAPC promotes innovation by providing open communication forums and specialized training through their
  • Leadership Centers and a Bootcamp for agencies starting Palliative Care programs. Opportunities to learn, grow and bust the myth are at an all-time high.
  • Technology–Although many technology companies have been reluctant to enter the Palliative Care market, several innovators have accepted the challenge and developed applications that help providers meet the specific needs of palliative patients.

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