Most clinicians have a conceptual idea of what palliative care is and where it fits in the spectrum of healthcare. Often it is thought of as pre-hospice care to transition individuals with a serious illness from active, curative treatment to end-of-life care. While this is true, palliative care should also be delivered in all aspects of healthcare.
The Fundamentals of Palliative Care
While it has formal definitions from the World Health Organization, the National Hospice and Palliative Care Organization (NHPCO) and the American Academy of Hospice and Palliative Medicine, at its core, palliative care is fully informed care. Fully informed care means people have a complete understanding of their illness and all treatment options, whether they be curative or palliative in nature. Everyone deserves to have this care, regardless of age or diagnosis.
Care is fundamentally shifting to being provided in the home, and palliative care is no exception. This is validated by payers offering coverage for community-based palliative care. Palliative care in the home has been proven to improve the overall care experience and reduce costs. However, in many areas of the country this is still an unmet need, and providing these services can be a business differentiator for a healthcare program. Therefore, NHPCO encourages community-based providers to evaluate the need and feasibility of providing palliative care in their community.
Starting Questions for Consideration
When considering a palliative care program, organizations should first determine the motivation to start a program. Is it to be a hospice feeder, a strategic partnership or to meet an unmet need in the community? Or is it a combination of the three?
Regardless, the next step is to perform an organizational needs assessment.
- Does the organization have the leadership bandwidth?
- Is the team healthy enough for a change and the addition of another service line?
- Can the organization financially support starting a program?
These are just a few of the surface questions that need to be explored when considering a community-based palliative care program. Once those initial questions are answered, secondary questions to ask are:
- Will this be a separate business? Or will this be a collaboration with another healthcare provider such as a hospice, home health organization or hospital?
- What will the care team look like? Will the palliative care providers be a separate and independent team, or will the organization borrow team members from other areas to support the palliative program?
- What reimbursement models will the organization pursue? Will care be strictly fee-for-service, or will the organization pursue value-based agreements or risk-based models?
There are many considerations to evaluate and explore as an organization considers starting a community-based palliative care program. The need for community-based palliative care is great, and it is admirable to start a program. However, it requires dedicated assessment and exploration of organizational priorities and meticulous planning if it is going to be a sustainable program that adds value to the community and brings quality to the lives of those served.
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