If You've Seen One Palliative Care Program: The Why and How of Developing Standards

Key Message: Variation in palliative care services compromises the field’s impact, reputation, and growth. Both Public and private payers seek standards for palliative care program structure and processes. This session highlights CAPC’s creation of recommended standards, minimum requirements, and their anticipated benefits in reliability, quality improvement, and payer relationships.

Abstract:

Background/Purpose: While the number of palliative care programs has tripled in the last twenty years (1), there remains substantial variation in palliative care program delivery, including team size and composition, services delivered, team availability, and patient volumes and length of stay (2). This variation leads to mixed outcomes at best, and at worst, confusion. Clinical program standards are a key component in a strategy for ensuring quality and accountability of palliative care (3).

Approach: The Clinical Practice Guidelines for Quality Palliative Care (NCP Guidelines), currently in its 4th edition define a framework for quality palliative care delivery, but do not specify minimum requirements for staffing, nor clarify exactly what services a patient and family receive. CAPC authors reviewed multiple state Medicaid regulations and private payer policies and identified vague (4) and disparate (5) requirements for palliative care that pose implementation difficulties for payers (6) and providers.

To facilitate implementing the NCP Guidelines, the Center to Advance Palliative Care (CAPC) created a minimum set of structure and process standards for palliative care programs across all settings. CAPC considered recommendations from a 2017-2019 expert panel, the Elevance QHIP Palliative Care Quality Measure, and existing state regulations. These standards have been shared with state policymakers, health plan representatives, and the Center for Medicare and Medicaid Innovation.

Implications/Lessons Learned: Ira Byock, MD, FAAHPM, published a white paper (3) setting forth a four-component strategy for ensuring the integrity of the field and improving access to and quality of hospice and palliative care. Panelists will discuss the CAPC standards within the context of payer activity and Dr. Byock’s white paper. They will consider challenges to adopting these standards and anticipated next steps. Ample time will be reserved to respond to feedback from participants.

References: 1. Growth of Palliative Care in U.S. Hospitals 2022 Snapshot, New York: Center to Advance Palliative Care, 2022.

2. Rogers MM, Sinclair S, Silvers A, et. al. Response to Kavalieratos: Directing the Narrative to Define and Present Standardization in Palliative Care (DOI: 10.1089/jpm.2019.0548). J Palliat Med. 2021 Mar;24(3):327-328. doi: 10.1089/jpm.2020.0710.

3. Byock I. A Strategic Path Forward for Hospice and Palliative Care: A White Paper on the Potential Future of the Field, Palliative Medicine Reports. 2025 Jan;6(1). doi: 10.1089/pmr.2025.0030

4. Hawaii MedQuest All-Plan Letter: QI-2430,FFS 24-12A, CCS-2410A, Community Palliative CAre Benefit Implementation.m_jf (part 1) - signed.pdf. Amended April 16, 2025. Accessed 28 April 2025.

5. Silvers A, Meier DE, Jaffe E, Krebbs R. Driving Improvements in Hospital Care through Palliative Care Quality Initiatives, Better Care Playbook Blog. 2020 June 11.

6. Vossel H. Payers to CMMI: We Need a Standardized Definition for Palliative Care. Hospice News. 2022 6 September. https://hospicenews.com/2022/09/06/payers-to-cmmi-we-need-a-standardized-definition-for-palliative-care/