Palliative care for seriously ill adults is spreading rapidly, giving rise to a fast-growing business sector: the home-based palliative care (HBPC) industry. These programs offer services common to most palliative care programs; what distinguishes them is that services are delivered to patients in their homes. Research shows these programs hold promise for improving patient outcomes at lower cost than usual care. Given this, growth in the HBPC business is likely fueled partly by the sector's money-making potential. As in many emerging industries, there are concerns that HBPC benefit may not be enjoyed equitably by patients and other stakeholders.
Objective:
To safeguard HBPC quality, we take stock of where quality problems may manifest and discuss strategies to forestall these problems.
Methods:
We examine HBPC trends with significant implications for care quality and cost, including HBPC payment, patient enrollment, staff management, and patient visits.
Results/Conclusions:
Recommendations pertain to quality metrics, patient disclosures, and further research.
BrumleyR, EnguidanosS, JamisonP, et al.: Increased satisfaction with care and lower costs: Results of a randomized trial of in-home palliative care. J Am Geriatr Soc, 2007; 55:993–1000.
6.
GomesB, CalanzaniN, CurialeV, et al.: Effectiveness and cost-effectiveness of home palliative care services for adults with advanced illness and their caregivers. Cochrane Database Syst Rev, 2013; CD007760. DOI: 10.1002/14651858.CD007760.pub2.
7.
LustbaderD, MudraM, RomanoC, et al.: The impact of a home-based palliative care program in an accountable care organization. J Palliat Med, 2016; 20:23–28.
8.
BishopL, ReeseM, KoomsonP, et al.: Health advanced illness management (AIM) 2016 Program Update (QI815). J Pain Symptom Manage, 2018; 55:707–708.
American Association for Hospice and Palliative Medicine: Proposal for a physician-focused payment model: Patient and caregiver support for serious illness. August 2017. https://aspe.hhs.gov/system/files/pdf/255906/ProposalAAHPM.pdf (Last accessed December20, 2018).
AldridgeMD, SchlesingerM, BarryCL, et al.: National hospice survey results. JAMA Intern Med, 2014; 174:500–506.
17.
WadheraRK, Joynt MaddoxKE, WasfyJH, et al.: Association of the hospital readmissions reduction program with mortality among Medicare beneficiaries hospitalized for heart failure, acute myocardial infarction, and pneumonia. JAMA J Am Med Assoc, 2018; 320:2542–2552.
18.
RosenthalE: An American Sickness. New York, NY: Penguin Random House, 2017.
U.S. Dept. of Health and Human Services O of the IG: Vulnerabilities in the Medicare hospice program affect quality care and program integrity: An OIG portfolio report (OEI-02-16-00570) 07-30-2018. https://oig.hhs.gov/oei/reports/oei-02-16-00570.asp (Last accessed January10, 2019).
Institute of Medicine: Dying in America: Improving quality and honoring individual preferences near the end of life. Published 2014. www.nap.edu/read/18748/chapter/1 (Last accessed December17, 2015).
MacReadyN: Telemedicine use increasing, parallels growth of parity laws. Medscape. www.medscape.com/viewarticle/905621 (Last accessed December21, 2018).
33.
SarmentoVP, GyselsM, HigginsonIJ, GomesB: Home palliative care works: But how? A meta-ethnography of the experiences of patients and family caregivers. BMJ Support Palliat Care, 2017; 7. DOI: 10.1136/bmjspcare-2016-001141.
HefeleJG, AcevedoA, Nsiah-JeffersonL, et al.: Choosing a nursing home: What do consumers want to know, and do preferences vary across race/Eehnicity?. Health Serv Res, 2016; 51:1167–1187.
36.
BardachNS, Asteria-PeñalozaR, BoscardinWJ, et al.: The relationship between commercial website ratings and traditional hospital performance measures in the USA. BMJ Qual Saf, 2013; 22:194–202.
