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Palliative Care News


CMMI DEPUTY DIRECTOR ELLEN LUKENS: CMS TO TAKE MULTIFACETED APPROACH TO
PALLIATIVE CARE

By Holly Vossel| April 21, 2023
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The Center for Medicare & Medicaid Innovation (CMMI) is considering a broad
spectrum of payment models that could integrate palliative care.

Palliative care providers offer a diverse range of services designed to meet
their patients’ complex needs, and forthcoming payment model demonstrations will
reflect this heterogeneity, fashioned with inclusive, yet measurable tools,
Ellen Lukens, deputy director of CMMI said at the Hospice News Palliative Care
Conference in Washington D.C.

This could include demos that fuse palliative care into Accountable Care
Organization (ACO) or primary care programs, among others.

“In terms of models, in general, we’re really thinking about how we leverage
accountable care and primary care models and other models to provide flexibility
to do different things in things like palliative care,” Lukens told Hospice News
at the conference. “It’s really important to give providers and other entities
that are testing these models tools to be successful. Thinking about where we go
from here, that’s a really important context as we think about the future of
palliative care.”

Ellen Lukens at the Hospice News Palliative Care Conference. Photo Credit: Mertz
Photography.

Health equity, quality and cost savings will continue to be crucial
considerations in model development going forward, she stated.

Ultimately, the goal is to have a health system that achieves “equitable
outcomes through person-centered, high-quality care,” with palliative care
likely playing a role, according to Lukens.

Health care organizations and other stakeholders have sought greater
opportunities for palliative care reimbursement as interest has grown among
providers, payers and investors. For instance, questions have percolated around
the potential for standardized quality measures, patient eligibility and care
delivery, as well as who should provide the service and who should pay for it.

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Currently, the patients most likely to be eligible for palliative care include
those who suffer from dementia-related illnesses, cancer, diabetes, heart or
kidney disease, Parkinson’s disease or stroke, according to the Center to
Advance Palliative Care (CAPC).

Some hospice industry groups for several years have called for a dedicated
palliative care benefit within Medicare.

While Lukens didn’t rule that out, she reiterated that CMMI is likely to take a
multi-faceted approach to palliative care.

“I don’t think it’s an impossibility that we would ever do a model for a
specific clinical condition or specific type of service. But again, I don’t
think of that as an either-or,” Lukens said. “Whether we’re talking about
palliative care in primary care or specialty care, we are increasingly
recognizing the heterogeneity of these entities and really focusing on allowing
them to participate in our models, but also ensuring that we really want to
achieve the same outcomes irrespective.”

Currently, palliative care providers can bill for physician services through
Medicare Part B. Other channels for reimbursement include Medicare Advantage
supplemental benefits, as well as payment arrangements with ACOs and Managed
Services Organizations (MSOs).

Palliative care is also an element of the hospice component of CMMI’s
value-based insurance design (VBID) demonstration.

Commonly called the Medicare Advantage carve-in, the agency recently extended
the demonstration period to 2030. Originally, the program was slated to end in
2024.

“In that [VBID] model, the Medicare Advantage organizations do have the
flexibility to design different arrangements, and I think that’s something that
we’re really interested in is our model’s test,” Lukens said. “What we really
want to see through this test is what happens, and is there some innovation in
the way that Medicare Advantage organizations [can] provide hospice care and
potentially palliative care. There’s also a lot of discussion around the cost
maybe driving some of that as well.”


HOLLY VOSSEL

Holly Vossel is a word nerd and a hunter of facts with reporting roots sprouting
in 2006. She is passionate about writing with an impactful purpose, and
developed an interest in health care coverage in 2015. A layered onion of
multifaceted traits, her personal interests include book reading, hiking, roller
skating, camping and creative writing.

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