128: Palliative Care: Healthcare’s Overlooked Middle Child May Finally Get Its Moment

Hannah Vale (0:03)

Welcome to Home Health Revealed, the podcast for Home Health and Hospice leaders who want to stay connected to the industry and ahead of what's next. Hi Annette, you're back. Hey, it's so good to talk with you today. I know we're doing an episode of Home Health Revealed, but I wanted to get you on here. You've been on here before, it's your repeat. I love a good repeat. And we've gotten to see each other in person, which is really so awesome. Always good to see you and hear you. I got to hear a session that you did recently. I think that was in California. I don't even recall where I was, but yes. But today we're going to be talking a little bit about the proposed rule as it relates to palliative care. So lots of questions, maybe more questions than answered, but we're going to talk about them. Will you start? I know I laughed earlier because you called yourself an old medical review nurse, although you're not old at all. None of us are.

We're all aging so gracefully.

But go ahead and give us your intro. Tell us what you do, kind of your background for anybody who might not know.

Annette Lee (1:06)

Oh, thank you, Hannah. It's always delightful to see you. So my name is Annette Lee, and I've been in the home health and hospice industry for well over 30 years. I kind of hate to say, hopefully I'm still weathering okay. But I love post-acute continuum, and so about a decade of that, I worked for the MAC and I did medical review and appeals, and very quickly they were like, hey, you're not the best bad cop. You're not great at denying these things because I came from the provider world. I'm a clinician, and so they've moved me to education, and that's really my passion. So now I help home health and hospice across the nation, trying to be compliant and give the best quality care. So that's where my heart is. And so I'm very excited that CMS is dipping their toe into the water to say, what can we do differently about palliative care? Because this has been such a nebulous thing. There's so many different ideas of what it is. And so I think starting with a definition would be fantastic if I may.

So palliative care is just an approach to care, right? It's not necessarily a palliative care benefit. We'll talk about that in a minute. But palliative care in general, anybody can provide care in a palliative manner. You could go see your oncologist and you could say, I want to approach this differently. I want palliative care, which means I'm not actively trying to conquer the disease, but I am trying to live my best life as comfortable as possible. It's about the quality versus the quantity. It is about palliating symptoms and feeling like you are really trying to address the whole person. So I think, again, whether I'm a home health or a hospice or a physician or any setting can really provide care in a palliative manner, the problem is, is that historically CMS has had very little true palliative care benefit. And so, you know, I think people wonder, well, what is it? And that creates all kinds of confusion.

So right now, the only thing that they truly pay a palliative care benefit is just physicians and other sub-providers, PAs, NPs, working with physicians, seeing that patient. And there is a code for palliative care for those providers. But it is not real well defined as far as can a home health or a hospice provide and bill it differently. Some insurance companies allow you to, but Medicare historically has not had that.

Hannah Vale (4:03)

Right. And it's definitely not standardized.

So from my perspective, billing wise, right? What we have seen, and you may have more to add to this, is people using the palliative care as a bridge for their continuum, maybe not even billing for it.

So it has been a loss leader, but it does provide that continuum of care, maybe even to bridge home health to hospice during what I'm just going to call in my own world, a maintenance period.

Annette Lee (4:34)

Yes. Yes. And I love when providers do think outside the box, but it's a shame that they many times do have to take a loss to do the right thing for patients. Right? Yes. And so, like you say, it does create a funnel for their hospice, and that's good for business. But in the meanwhile, there's a lot of expenses that they incur to just do the right thing by the patient. And so, of course, they can bill for the physician, they can bill for the NP, but they are many times supporting just out of their own pocket, maybe some support from just a nurse or an aide or a social worker. And so, you know, that's problematic. That is not sustainable.