Hospitals in pursuit of excellence

Next Generation of Palliative Care: Community Models Offer Services Outside the Hospital

Acute care hospitals have been establishing palliative programs at a rapid pace; the United States now has more than 1,600 of these team-based programs that focus on relieving symptoms and improving quality of life for patients with serious illness. But when patients leave the hospital setting, the lack of community-based palliative care becomes a problem. This report looks at emerging palliative care models that aim to fill the gaps, including:

• Hospice-based: Although hospice care has eligibility barriers under Medicare, some model programs are providing extensive non-hospice palliative care in Kentucky, North Carolina, and Virginia.
• Outpatient clinics: Palliative care based in outpatient clinics is an emerging trend in California. Services are typically subsidized by a hospital or health system, often with an expectation that the care will reduce non-beneficial acute and emergency services.
• Medical groups: Several medical groups in Southern California have applied expertise gained by hospital-based palliative care to other settings such as primary care practices.
• Integrated delivery systems: Kaiser Permanente and the Department of Veterans Affairs are examples of large, integrated systems that have devoted considerable resources to experimenting with models of palliative care in and out of the hospital.

This report finds that organizations and providers interested in creating or enhancing community-based palliative care programs will need to develop local information about needs and goals for their program, what it will do, who it will serve, how it will function, and how it will be financed. A number of policy shifts could encourage the spread of such models. The clearest need is to adjust reimbursement mechanisms and develop financial incentives to support care coordination and palliative services in any setting.