Terminally ill patient hooked up to machine receives lifesaving care at home

The leader of the National Hospice and Palliative Care Organization (NHPCO) said Monday that there is a strong possibility that Medicare will begin offering a community-based palliative care benefit this year.

“We’re incredibly hopeful that this is the year after decades of talking about it that we’re actually going to get a benefit that we can wrap our arms around,” said Edo Banach, J.D., president and CEO of NHPCO, during the keynote address of the first day of the virtual 2021 Leadership & Advocacy Conference. “And that would be so important and so huge.”

Headshot of Edo Banach
Ed Banach, J.D., CEO and President, National Hospice and Palliative Care Organization

NHPCO had been engaging with the Centers for Medicare and Medicaid Services’ Center for Medicare and Medicaid Innovation regarding a community-based palliative care program even before the pandemic, he said.

“Community-based palliative care is going to allow folks not to have to give up curative care in order to get palliative care,” Banach said. “And we can build in quality metrics and understandable pathways really from the get-go.”

CMS has allowed Medicare Advantage plans to cover palliative care as a supplemental benefit, but it has stopped short of providing national coverage. One reason is the murky definition of palliative care, which NHPCO said “focuses on the pain, symptoms and stress of serious
illness most often as an adjunct to curative care modalities.”

Those who receive it have “a serious illness, regardless of life expectancy or prognosis,” NHPCO said.

One critical aspect of the definition is the ability for someone receiving palliative care to also receive curative care. The hospice benefit currently requires patients to forego other treatments.

A community-based palliative care benefit would be “a silver lining of the pandemic,” Banach said Monday.

Banach noted other notable continuing payment reforms. These include value-based care; and the Medicare Advantage Value-Based Insurance Design Model (V-BID), through which the Centers for Medicare & Medicaid Services is testing a range of MA innovations designed to reduce expenditures, enhance quality of care for Medicare beneficiaries, and improve healthcare service delivery, such as hospice.