The first proposal for discussion was the American Academy of Hospice and Palliative Medicine’s proposal for a Patient and Caregiver Support for Serious Illness (PACSSI) model. AAHPM representatives did an excellent job answering questions from the PTAC. Several PTAC members expressed the urgency for a care model for the seriously ill and their families. The PTAC members recognized a gap in care exists and expressed the importance of creating a distinction between palliative care and hospice while encouraging close collaboration between both services. The PTAC voted to “Recommend to the Secretary limited scale testing of this model”. The PTAC’s vote reflected support for 8 of the 10 criteria.
Several stakeholders expressed support for the PACSSI model. As NHPCO’s Vice President of Palliative and Advanced Care, I was able to provide public comment on behalf of NHPCO to emphasize three main points:
1. The PACSSI survey used to obtain patient reported outcomes and experience of care builds on the existing Hospice CAHPS survey, which is designed to measure and assess the experiences of patients who died while receiving hospice care, as well as the experiences of their informal primary caregivers. Use of these NQF-endorsed measures supports seamless care delivery for seriously ill individuals and their families experiencing PACSSI and hospice care.
2. The process measures align with the domains of care recommended by the NCP Clinical Practice Guidelines for Quality Palliative Care (3rd edition) and support access to an interdisciplinary team that includes physicians, nurses, social workers, therapists, home health aides, spiritual caregivers, bereavement counselors, and others as needed, for seriously ill individuals and their families.
3. Hospice is the gold standard in evidence-based care for terminally ill individuals Existing palliative and advanced care programs demonstrate that seriously ill individuals experience more timely access to hospice care. We would expect a model that closely coordinates care between the model and hospice, with the goal of improving the length of stay in hospice. Using the hospice median length of stay, currently at 17 days, may be a better reflection of a quality measure. Furthermore, for those concerned with long lengths of stay in hospice, the PACSSI model offers an alternative that addresses a current gap in care and support service. I would expect a shorter length of stay in hospice for long stay patients, where patients in the model may be referred to hospice later in their disease trajectory.
Additional speakers included Sandy Marks representing the American Medical Association (AMA), she expressed support of the PACSSI model. Dr. Diane Meier provided public comment on behalf of the National Coalition for Hospice and Palliative Care. Betty Ferrell spoke on behalf of HPNA. Dr. Martha Twaddle and Dr. Dana Lustbader also provided comments based on their experience in the field. Betty Ferrell and Dr. Martha Twaddle have co-chaired the revision of the National Consensus Project Clinical Practice Guidelines for Quality Palliative Care, 4th edition, expected to be out in mid-2018. Dr. Lustbader is co-presenting an NHPCO webinar in April on Advances in Telehealth for Palliative Care and Hospice.
The Coalition to Transform Advanced Care (C-TAC) followed the AAHPM presentation with the second round of their proposal, Advanced Care Model (ACM), focused on the same patient population. The PTAC also voted to “Recommend to the Secretary limited scale testing of this model.”
The PTAC expressed their desire to urge CMS to develop a model as soon as possible that recognizes the strengths of both models rather than recommend either model for implementation. After much deliberation, the PTAC determined they would combine their letter of recommendation for PACSSI and ACM because they saw pros and cons to both models. They encouraged ongoing collaboration between all stakeholders to develop a palliative care model for the seriously ill. You can find more information on the PTAC website.
NHPCO is actively collaborating with the National Coalition for Hospice and Palliative Care, AAHPM, CMS, and other stakeholders to offer our expertise in providing care for the seriously ill and ensuring that patients and family members are an integral part of the care plan. NHPCO encourages members to be ready to participate in a CMS model, if available. To prepare our members for this tremendous opportunity, NHPCO is working on creating resources to help operationalize and sustain palliative care programs regardless of whether a model is launched by CMS or not. The NHPCO Palliative Care Council reconvened on March 23rd, to assist in these efforts. Providers can join the Palliative Care community on my.nhpco.org and also participate in a member survey on palliative care, coming out in May.
Lori Bishop, MHA, BSN, RN, CHPN is Vice President of Palliative & Advanced Care at the National Hospice & Palliative Care Organization.