Federal advisory panel urges creation of palliative-care model

A federal advisory panel is recommending that HHS pursue new models of care for Medicare patients in need of palliative care.

The Physician-Focused Payment Model Technical Advisory Committee, known as PTAC, voted Monday to forward proposals for two alternative payment models for review by the HHS secretary. The panel believes the ideas can be merged into one as both involve forming multidisciplinary care teams for patients in advanced stages of illnesses, but who are not yet ready for hospice care.

While this population only makes up 4% of Medicare beneficiaries, it accounts for 25% of annual Medicare expenditures, according to researchers. Better coordination between providers could not only improve quality of care, but reduce costs, advocates for the new pay models argued.

These patients "are in a cycle now of being in and out of the hospital, pushed around from doctor to doctor without getting their needs met," said Nick Martin, a spokesman for the Coalition to Transform Advanced Care, a national alliance dedicated to reforming advanced illness/end-of-life care in the U.S.

To that end, providers developed two models that were reviewed by PTAC. One, the Patient and Caregiver Support for Serious Illness model, was submitted by the American Academy of Hospice and Palliative Medicine. The second was the Advanced Care Model Service Delivery and Advanced Alternative Payment Model, submitted by the Coalition to Transform Advanced Care.

Under both models, doctors, nurses, and spiritual providers would work together under such incentivized payment arrangements as risk payments or care-management fees to develop and execute a coordinated care plan for seniors in advance stages of illness.

Providers in the space are thrilled the panel is pushing the models through to HHS for review.

The resulting demonstration would allow both providers and the CMS to learn which quality measures and incentives best improve care and outcomes in the palliative space, according to Dr. Phil Rodgers, a palliative-care doctor at the University of Michigan who helped develop the Patient and Caregiver Support for Serious Illness model.

"It's imperative CMS move in this space with deliberate speed. In fact, the U.S. public should demand it," Dr. Tim Ferris, a PTAC member and CEO of the Massachusetts General Physicians Organization, said at the meeting. "Half of the patients that I see at the hospital would probably not be in the hospital if they had this kind of support."

Dr. Robert Berenson, a panel member and fellow at the Urban Institute, expressed overall support for an advanced payment model being developed for palliative-care patients, but was concerned about the use of incentive payments.

"We don't need to offer financial incentives for what should be good practice" of medicine, Berenson said.

Rodgers said there would likely be an openness from stakeholders to work under an incentive approach that differed from the ones outlined Monday at the meeting, but he believes some version enhanced payment should be offered.

"You have to provide sufficient payment to deliver high quality interdisciplinary care," Rodgers said.

It's unclear when or if HHS will act on PTAC's recommendations. The panel was established by the Medicare Access and CHIP Reauthorization Act of 2015 , to provide comments and recommendations to CMS on physician payment models.

However, a Health Affairs analysis posted Monday found that HHS has yet to act on any of the recommendations it has made.