CAPC Factsheet: Palliative Care Across Settings

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Palliative care is specialized care for people living with a serious illness, focused on relieving the symptoms and stress of the illness. The goal is to improve quality of life for both the patient and the family.

Palliative care is delivered by a team of professionals and should be available in all settings, especially acute care hospitals, clinical offices, post-acute and long-term care facilities, and patients’ homes.  Regardless of setting, palliative care entails the following, consistent with the National Clinical Guidelines for Quality Palliative Care:

• Interdisciplinary team care delivered by certified specialists, including medicine, nursing, social work, and chaplaincy 
• Comprehensive symptom and functional assessment
• Proactive pain and symptom management
• Effective communication that clarifies what to expect and supports decision-making that aligns with patient goals and values
• Relief of psychological, emotional, and spiritual suffering
• Ongoing family caregiver assessment and support
• Coordination among all clinicians involved in the patients’ care

Palliative care services can vary according to setting, based as factors such as which patient populations are primarily served and how the palliative care team interacts with the patient and with other clinicians. In addition, current payment models impact populations served and delivery models.

Setting	Target Populations	Delivery Approach	Current Payment Models
HOSPITAL	Intensive care units Medical and surgical care units Emergency departments	Palliative care professionals consult with referred or identified patients, and coordinate with treating team Visits may be daily or until needs are met Palliative care team utilize staff from the hospital’s Social Work, Chaplaincy, and other departments Key hospital staff – such as Hospitalists and Critical Care Nurses –  should have basic training in communication and pain/symptom management Some large hospitals may have dedicated palliative care units, where palliative care is the primary treating team	Hospital salary support, supplemented with professional billing Palliative care contributes to hospital value-based payment outcomes
OFFICE/CLINIC	Oncology  Cardiology/heart failure  Pulmonary  Neurology  End-stage renal disease/Dialysis Primary Care	Palliative care professionals co-located in the office, conducting visits with referred or identified patients Additionally/alternatively, case managers with additional training are embedded in the treating team Some palliative care teams maintain their own offices	Professional billing Salary support from health system
LONG-TERM CARE	All patients/residents should have clarified goals and advance care planning conversations Screening for symptom burden should lead to additional palliative care services	Palliative care professionals consult with referred or identified patients and residents Visits may be daily or until needs are met Long-term care organization may contract with a partnering community-based palliative care team to provide visits Palliative care team may be created with staff from Social Work, Chaplaincy, and other departments Medical, nursing and social work staff should have basic training in communication and pain/symptom management	Professional billing
HOME-BASED	Patients with both serious illness and functional impairment, at risk for exacerbation and hospitalization	Members of palliative care interdisciplinary team visit on different schedules Visit intensity varies with patient need 24/7 access to palliative care clinicians, to ensure meaningful and timely response to crises Telehealth and community paramedicine may be deployed to ensure timely response	Professional billing Alternative payment arrangements through Medicare Advantage or other health plan

6/15/2020