Pioneer healthcare programs are difficult to finance because traditional reimbursement streams typically will not pay for their services until these new programs become almost old programs that have proliferated and proven their effectiveness time and again. Such is the case with almost all palliative care programs at this stage of their development: There currently is no explicit third-party reimbursement for these services, whatever form they may take. "No single 'magic' bullet approach to financing palliative care has been identified," concludes a technical assistance monograph prepared by the National Hospice and Palliative Care Organization in conjunction with the Center to Advance Palliative Care (2001). Consequently, "the financing of palliative care is and will remain one of the biggest challenges for hospital administrators (NHPCO/CAPC, 2001)."
How is it then that, despite this financial Catch-22, palliative care programs have grown in number and importance in recent years? Perhaps the most pointed answer is found in the adage, "Where there's a will, there's a way." In hospitals, hospices, nursing homes, and home health agencies, determined champions of palliative care have launched their programs using a patchwork of funding from multiple sources, including existing reimbursement streams — for hospice care, home care, physicians services, etc. — as well as foundation grants, clinical research initiatives, medical fellowships, and institutional subsidies. Funding challenges and opportunities vary depending on the structure and setting of the palliative care program. For instance, the financing plan for a hospital-based program focused on research and education will look different from that for a community hospice organization concerned with expanding direct services.
This chapter examines funding for and regulatory issues pertaining to palliative care programs modeled after the TriCentral Palliative Care (TCPC) Program; that is, programs based in dually certified hospice and home health agencies that provide direct patient and family services. Within this context, we look at palliative care services offered through capitated managed care organizations (MCOs), such as Kaiser Permanente, which houses the TCPC Program, and through community-based home health agencies. As always in the shape-shifting world of healthcare, readers should be aware that the rules and regulations governing hospice and home health agencies are constantly changing, so administrators and practitioners need to keep abreast of new developments and "be proactive in defining strategies for their organizations to avoid problems (Adeniran, 2002:111)."
Capitated Managed Care Organizations
TCPC Program Financing
Financing for Community-Based Home Health Agencies
[ Go Up ]
For more information about the TriCentral Palliative Care Toolkit visit www.growthhouse.org/palliative/. All content is Copyright © 2002, 2003 by Richard D. Brumley, M.D. All rights reserved. No part of this toolkit may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without written permission from the publishers. This guide to developing home-based outpatient palliative care services was developed through a grant to the Kaiser Permanente TriCentral Service Area from The Project on Death In America. The Kaiser Permanente TriCentral Palliative Care Program is a Sustaining Member of the Inter-Institutional Collaborating Network On End-of-life Care (IICN) which links major organizations internationally.
