Q&A with Nick Westfall: Filling the Palliative Care Gap

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Nick Westfall

Healthcare leaders are focused on the future: after several years of disruption and adaptation, it’s time to apply lessons learned. Nick Westfall, President and CEO of VITAS® Healthcare, the nation’s leading provider of hospice care, answers questions about palliative care today and the steps we can take to better serve our local communities, individual patients and their families, as well as the healthcare system as a whole.

Let’s level-set: from your view, what is the system doing well right now?

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That’s a great place to start. There are certainly many areas for improvement in healthcare delivery, but it’s important to take stock of what we’re doing right. Hospice care has been delivering essential care to seriously ill patients – and much-needed caregiver support for loved ones – for decades. For patients nearing the end of life, it provides care in their home or other settings to manage pain, symptoms and stress, improving their quality of life.

Hospice care also is an invaluable Medicare benefit that has been shown to lower total cost of care and improve quality for both the patients and their families. A recent cohort study published in the JAMA Health Forum, showed that hospice use by community-dwelling Medicare beneficiaries was associated with significantly lower total healthcare costs across all payers in the last three days to last three months of life. 

What are some of the high-priority challenges we need to solve?

Access is one of the most significant challenges – too often patients aren’t getting end-of-life care or palliative support when they need it. Patients qualify for hospice when they have a prognosis of six months of life or less and have progressed through disease-modifying treatments. However, despite being entitled to at least six months of care, 25% of patients are with hospice for less than five days. We need to close that gap so patients can have a better quality of life at the end of life.  

Further, patients with serious illnesses and chronic conditions should be able to find relief prior to hospice, while they’re still receiving curative care. They need access to palliative care to address the pain, symptoms and stress that begin long before the six-month time marker. 

Increasing access to palliative care has the potential to help not only individual patients, but to deliver better results for the healthcare system by improving outcomes, reducing hospitalizations and lowering the overall cost of care. We know there’s a significant population who could benefit from palliative care: 12.4 million Americans, according to The Center to Advance Palliative Care (CAPC).

What do we need to do to increase access to palliative care?

The positive news is that we’re starting from a place of strength; our existing system is well positioned to provide more patients with community-based palliative care. CAPC also shared that hospice represents at least half of the nation’s in-home palliative care providers. However, many patients still face barriers to access. Patients with traditional Medicare do not have coverage for palliative care, despite the fact that most private insurance plans and more than 100 Medicare Advantage plans do cover palliative care. We need a robust and defined Medicare benefit for community-based palliative care to ensure these patients get the care and relief they need. 

What are the implications of a Medicare benefit for community-based palliative care?

The first and most important effect of this benefit would be improving outcomes, followed by reducing overall costs for people living with serious conditions. The resulting ripple effect could benefit the larger healthcare system. First, removing barriers to access for palliative care could also help remove barriers to hospice. Patients and families would be familiar with palliative care and its benefits, supporting earlier and more seamless transition to hospice care. The key here is that a properly defined community-based palliative care benefit complements the hospice benefit—it doesn’t cannibalize it.

A Medicare benefit for community-based palliative care also is likely to support another vital metric: reducing unnecessary hospitalizations. A community-based payment model for palliative care could produce hundreds of millions of dollars in savings to the Medicare program, according to preliminary results from the National Opinion Research Center. 

What does a robust and defined Medicare benefit for community-based palliative care look like?

The hospice community has identified several key factors that we urge the Center for Medicare and Medicaid Innovation (CMMI) to consider in structuring a care delivery and sustainable payment model for palliative care.

First, this model should be driven by registered nurses and social workers, many of whom already have the experience in home-based clinical and social determinants of health necessary to care for seriously ill patients. With the expansion and evolution of telehealth, physicians and nurse practitioners can provide oversight virtually. Another important element will be prioritizing payment for care coordination between those providing palliative care and the providers delivering alternative curative care. Finally, the goals of this model must strategically align with the hospice benefit to support earlier access to hospice through enhanced advance care planning and education for patients and their families.

We believe that if CMMI implements a community-based palliative care benefit with this approach, it will support improved outcomes for all, helping our nation’s most seriously ill patients navigate the end of life without unnecessary, high-cost and burdensome transitions. Hospice care providers stand ready to serve.

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