Whereas the coronavirus pandemic has delivered to mild the rising vital want for expanded palliative care programming, its financial ramifications have many suppliers navigating uncharted monetary waters. Strategizing by the general public well being disaster will contain minimizing operational bills whereas branching out to non-traditional income sources.
Greater than half of community-based palliative care suppliers in america are hospices, in keeping with the Middle to Advance Palliative Care (CAPC).
“Palliative care team leadership is challenged in the COVID era to plan and hope for the best while getting prepared for the worst,” stated Diane Meier, M.D., director of CAPC, in a latest webinar. “It’s the same thing we say to patients and families, and we should be saying this very thing to ourselves. Maximizing the likelihood that our programs will survive through this financial crisis for health care will take developing a strategy for planning forward with practical and feasible steps.”
Cautious income cycle administration will develop into more and more vital because the financial fallout of the pandemic proceeds. Roughly 30% of palliative care revenue stems from fee-for-service billing, with smaller quantities coming from sources like non-public Medicare contractors and philanthropic funding.
Two-thirds of suppliers depend on outdoors sources corresponding to employers, hospitals, well being techniques and hospices to help palliative care workers groups, in keeping with information from the CAPC Nationwide Palliative Care Registry.
Heavy reliance on outdoors funding sources amid pressures ensuing from the COVID-19 pandemic have many palliative care suppliers involved about their long-term monetary sustainability. Important planning steps to outlive unsure occasions of palliative care viability embrace maximizing revenues and minimizing bills, in keeping with Meier.
“A lot of this is under our control,” stated Meier. “We can demonstrate stewardship on both the expense side of our palliative care services and on the revenue side. On the expense side, we can be more accountable for operational efficiencies, making sure we are making the highest and best use of precious human resources, our teams. On the revenue side, we can make sure we are maximizing fee-for-service billing and simultaneously seeking alternative payment and income sources. These are essential forward planning steps to ensure that our resources are sustainable.”
Suppliers can study to maximise earned income from billing sources corresponding to non-public insurance coverage suppliers and fee-for-service Medicare. As payors, together with Medicare, more and more favor value-based fee preparations corresponding to Medicare Benefit, suppliers have responded by reshaping their models of affected person care to raised align with these stakeholder pursuits.
Whereas suppliers will doubtless profit from persevering with to pay shut consideration to their fee-for-service billing, Meier advises them to not overlook alternatives to bolster revenue by applications corresponding to Medicare Benefit.
“Most of us are leaving a lot of fee-for-service money on the table, and we can’t afford to do that anymore,” Meier stated. “This is understandable, given a complicated, obscure and confusing payment system. The palliative care field has been hesitant to wade into the contracting world, but if there was ever a time to consider payment options outside of fee-for-service billing, now is that time. Medicare Advantage is rapidly taking over fee-for-service, and an increase in early retirement due to economic downtown [during the pandemic] may bolster enrollment further.”
By way of Medicare Benefit, CMS contracts with non-public insurance coverage firms to supply protection. In accordance with information from Avalere Well being, medical insurance firms corresponding to Anthem, Cigna, Humana and United Healthcare confirmed development in Medicare Benefit enrollment since from 2019 to 2020, resulting in projections that plans will present protection to an estimated two-thirds of Medicare beneficiaries (64%) by 2028.
Regardless of rising Medicare Benefit enrollment charges, palliative care suppliers stay involved about methods to make sure ample fee amongst unclear flexibilities in billing and coding for his or her providers.
Meier beneficial preserving open strains of communication between leaders and their group’s coders and billers, in addition to routinely checking coverage bulletins from their native authorities companies and personal payers to make sure compliance and applicable billing for providers rendered to sufferers.
“If leadership is not already meeting with coders, billers and auditors on a quarterly basis, then begin now,” Meier beneficial as a step in the direction of palliative programming sustainability. “Ensure you are measuring your patient encounters, both time-based and evaluation of management, appropriately. Are you using documentation templates that support the highest levels, the highest and most appropriate levels, of coding and billing? And do you have [electronic health record (EHR)] templates to support advanced care planning, time-based billing, prolonged service codes, non-face-to-face billing and medical decision-making? If you make it easy on your clinicians to bill appropriately, they will do so. If it’s a hassle, if it requires more thinking, more time, more clicking, then they won’t.”
One other technique that palliative care suppliers can make use of whereas using out the pandemic’s monetary influence is constructing efficiencies to reduce bills. Rising private protecting tools (PPE) costs and elevated know-how prices with expanded telehealth utilization has financially strained many organizations. Offsetting these and different pandemic-related prices will embrace enhancing operational efficiencies in staffing and affected person administration.
Even amid these monetary pressures, workforce psychological and bodily well being has develop into more and more essential in the course of the pandemic. Help from management on issues corresponding to anticipated paid break day wants, free and confidential counseling help, together with peer-to-peer digital help have develop into routine for a lot of organizations.
“We need to assume people will need to take time off, vacation and sick time. We need to make sure we aren’t understaffing, but instead overstaffing,” Meier stated. “We’ve seen the power of peer support and making people feel seen, recognized, understood, valued, and supported. The way we need to do that is by operationalizing that support as a routine, not as something that only comes up when there’s a crisis, but something that occurs once a week.”
