For the final blog post of this series, we will be focusing on challenges and implementation strategies of pediatric palliative care models in coordinated care environments. In previous posts, we discussed the need for initiating pediatric palliative care and reimbursement successes in the inclusion of pediatric hospice concurrent care in the Affordable Care Act.
First, let's review some basic differences in pediatric palliative care and hospice care. The following chart is adapted from a report from the Catalyst Center, Financing Pediatric Palliative and Hospice Care (2011):
|
Palliative care |
Hospice care |
| What is the timing? |
- No restrictions on when it can begin
- Ideally initiated at diagnosis and continued throughout the disease process
|
- Terminal illness only (typically defined as six months or less life expectancy)
|
| What is the payment structure? |
- Coverage varies widely across insurance
- Often services that are not a part of medical care (i.e., family respite) are not typically covered by private insurance
- Limited revenue from direct billing
- Highly supported by philanthropic endeavors (grants, donations, hospital funding)
|
- Coverage varies widely across insurance
- Typically administered through a hospice agency
|
| What does the treatment consist of? |
- Comfort and support
- Symptom-driven
- Goal setting for patient and family
- Can occur alongside curative therapies
|
- Comfort and support
- Symptom-driven
- Goal setting for patient and family
- Now with changes through the Affordable Care Act, may happen alongside curative therapies in pediatric population
|
|---|
How is pediatric palliative and hospice care financed?
Medicare and Medicaid play a large role in reimbursement of services for palliative care and hospice. Because of the lack of pediatric enrollees for Medicare, we rely on Medicaid to cover the pediatric population through waiver programs (Catalyst Center, 2011). According to the National Hospice and Palliative Care Organization, many insured children have similar barriers to achieving coverage as private insurers do not cover curative or substantial palliative care services as a part of their benefits (Catalyst Center, 2011).
Even if the child is eligible for some kind of Medicaid or private insurance coverage, this often does not cover all costs associated with care. Presently, many hospitals have focused on philanthropic or grant-funding mechanisms to establish and maintain pediatric palliative and home hospice benefits. While this has allowed them to become established, they also have the burden of knowing that their work is "living on soft money" and require additional development efforts beyond the direct medical, nursing, and social work support.
I know as a nurse in the pediatric ICU, I was often frustrated when wondering why palliative care or hospice options weren't presented sooner, which caused me to question and dig to find some answers. This journey has allowed me to find a new passion directly related to oncology practice, and has presented a complex overlap in understanding how provider and policy-related barriers are connected to achieving best-practices.
If your center does have a thriving pediatric palliative care and/or hospice program, do you know how it's funded?
What issues have you become passionate about through your clinical practice settings?
References:
- Financing Pediatric Palliative and Hospice Care Programs, a publication of the Catalyst Center: Improving Financing of Care for Children and Youth with Special Health Care Needs, April 2011. Retrieved from: http://hdwg.org/catalyst/node/197. Accessed April 2012.
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