Patients who are coming out of a hospital, skilled nursing or rehabilitation stay are called “transitional” patients because they are going from a healthcare entity back into their own home, where they are responsible for their own health and medication management. Depending on what they were being treated for and their age, this can be a daunting task.
While certainly not a new concept, transitional care programs add diversity in patient management tools and services an agency can provide to support patient outcomes and, in turn, business outcomes. There are many options to choose from, but palliative care is undoubtedly the fastest growing transitional care program.
Advantages of palliative care
Palliative care can be beneficial for any service line. It is not confined to a single healthcare “bucket.”
While typically thought of as a hospice service, palliative care is not geared exclusively toward end-of-life patients. Palliative care focuses on the patient’s needs and goals instead of their prognosis, so it is viable at any stage of an illness. This service can be used for symptom management as well as consultative purposes. It is distinctly different from hospice care because it can be administered alongside curative treatments. As regulators slowly introduce more palliative care allowances, care at home providers are inevitably embracing this nebulous service line.
Palliative care as a transitional care program
Because palliative care is not a federally defined benefit, every agency has its own interpretation of what a palliative care transitional program looks like.
In its raw form, transitional care assists a patient in navigating available health services or helps connect the patient to additional services. Transitional care and palliative care programs can also act as an extension of the current care team. There are currently two known Medicare transitional care models that can be used by a palliative program: Transitional Care Management (TCM) and Chronic Care Management (CCM).
In addition to these more structured programs, a palliative organization can leverage evaluation and management billing codes for medically necessary pain and symptom management needs that do not duplicate services already covered by TCM or CCM.
How to know if transitional palliative care is the right business move?
Home healthcare organizations considering adding a transitional palliative care program should first evaluate their current census. Hospice organizations should look at how many patients they are turning away because they are not yet eligible for the Medicare hospice benefit. Home health agencies should consider how many patients could benefit from additional support with symptom management and goal setting.
Most agencies can run a transitional palliative program with a nurse practitioner (NP) and a medical assistant or healthcare navigator. This minimal requirement for an existing agency also lowers additional overhead costs. Organizations that stay on top of the few regulations that exist, like the ability to charge for psychosocial visits, can use these strategic reimbursements to remain sustainable.
With the cost and reimbursement estimates, organizations can determine how much it will cost to start and run the business and then perform a cost-benefit analysis, a tool created to reduce the cost of quality healthcare.
Having a transitional palliative program will help an agency have broader access to patients and assist patients that are in that “no man’s land” of our healthcare system. Patients who do not qualify for hospice care yet and need more symptom management support than what home health can provide are excellent candidates for a palliative care transitional program.
Palliative care is a specialty that is not offered in every community, so referral sources (such as primary care physicians, oncologists, cardiologists or pulmonologists) may not have anywhere to send these patients. Instead of turning them away, offering a palliative care transitional program will maintain contact and a relationship with a patient in between their eligibility for different service lines and ensure continuity of care. This type of program can be a strong asset for your business and the needs of the community.
Amy Rose is the director of the palliative care solution for Axxess. She is responsible for providing industry thought leadership and strategic direction and delivery of Axxess Palliative Care. She previously served as chief operating officer for Sangre de Cristo Community Care, overseeing the acquisition of three home health organizations and creating urban and rural palliative practices in inpatient, home care and clinical settings.