Nine U.S. senators are calling for Medicare and Medicaid to begin covering palliative care, a service not currently available under either of the federal programs.
The bipartisan group of senators signed onto a letter last month calling on The Center for Medicare & Medicaid Innovation to begin a demonstration project and develop a plan to cover palliative care in the future. Three of the four co-founders of the Senate Comprehensive Care Caucus, founded in 2019 to “promote the availability and benefits of palliative care,” signed on to the letter.
“Studies have shown the critical importance of palliative care, which looks at the patient as a whole and addresses quality of life, symptom management, and supports for both the patient and their caregivers,” reads the open letter. “It not only yields better health and quality of life outcomes but can also decrease stress for the entire family. This type of compassionate, comprehensive care integrates clinical and community-based services, improves care coordination, uses an interdisciplinary team to focus on patient-centered care, and reduces discomfort and disability.”
Palliative care is similar to hospice care in that it’s interdisciplinary care to ease mental and physical burdens in addition to curative treatment. However, John Mulder, MD, a hospice and palliative care practitioner and director of the Division of Palliative Medicine at Michigan State University College of Human Medicine, said palliative care differs in that it does not require a limited prognosis like hospice does. He says shortly after the birth of hospice care in the 1960s, health care providers began using elements of hospice to treat people who were not imminently dying. Both styles of care can involve additional personnel beyond doctors and nurses, including chaplains and social workers.
“It often is more than just getting a pain prescription,” Mulder said. “It is more than just figuring how to manage the nausea related to the disease. It’s more complex. Often it does involve a nurse case manager to help manage the complexities of what’s going on and to knit all the pieces together. It often does involve some psycho-spiritual care.”
Mulder said hospice care was first covered under Medicare and Medicaid in 1982 and was an early example of a per diem benefit. Instead of the benefit paying the provider for each service provided – such as each separate medication or procedure – Medicare and Medicaid pay the provider for each day the patient spends in hospice care, and the provider takes whatever measures are necessary to care for the patient. Since the introduction of the hospice benefit, patients have needed a prognosis of six months or less to qualify.
The Center for Medicare & Medicaid Innovation, which the letter specifically calls on to take action, is a division of the Center for Medicare and Medicaid Services charged with changing the programs’ approach to health care as science progresses and the needs of the population change.
Originally known as the CMS Innovation Center, CMMI was established under the Affordable Care Act of 2010. Mulder says CMMI examines not only treatments but also funding mechanisms and rules governing hospitals and providers to address the consequences of any changes in other areas of the health care landscape.
“It’s an attempt to identify the fact that life changes, medicine changes, and science and technology change,” Mulder said.
This examination is often done through demonstration projects, trials which test potential changes to the programs. The letter specifically calls for a demonstration project on palliative care.
Mulder said he spoke to people at CMS about palliative care coverage 15 years ago, and that palliative care may not be a priority for CMS—not because of a lack of people advocating for it but because it doesn’t have the urgency or visibility of some other changes in the health care world CMS has had to deal with. He cited heart transplants, new drugs for rare diseases, and response to the COVID-19 pandemic as issues that may hold more urgency in the eyes of CMS. He said the success of palliative care coverage by major private insurance programs may have motivated the current push by the nine senators to get the benefit under Medicare and Medicaid.
“It’s not that people haven’t cared about this,” he said. “It’s not that we haven’t been active in this. It takes the right political climate, and it takes capturing the right ears of those inside who are willing to champion this cause. If you don’t have a champion on the inside, it isn’t going to happen.”