Tuesday Health

A leading industry voice confirmed something important about the future of palliative care access.

Earlier this year, CMS clarified that palliative care can be billed under the Medicare home health benefit. It was a meaningful signal. But a new report digs into what that actually looks like in practice.

According to the National Alliance for Care at Home, most home health agencies offering "palliative care" today aren't delivering it through the home health benefit at all. They're doing it through a separate physician visiting service, because the home health payment structure makes a truly interdisciplinary palliative care program; nurses, social workers, physicians, all working together, cost-prohibitive to build.

That's not a criticism of home health. It's an honest look at what the numbers actually support.

This is exactly why purpose-built palliative care exists. Not layered onto a benefit designed for something else, but built from day one around a full care team, working together, with the singular goal of helping people live well with serious illness.

The conversation about how Medicare supports this work is evolving in the right direction. We're glad to see it getting more precise, and more honest about what it will actually take to close the gap.

How Palliative Care Works within Home Health Palliative care as delivered by home health agencies can look very different that provided by a hospice. Earlier this year, the U.S. Centers for Medicare

"I don't know what I'd do without this team."

Profound hearing loss had made it hard for one of our members to fully take part in conversations about her own care, leaving her at risk of decisions being made for her, not by her.

Our nurse practitioner brought communication tools and time. She walked her through her options carefully, patiently, with visual support.

For the first time, she fully understood her choices. She made an informed decision. Her family now knows her wishes.

Care that adapts to the person, not the other way around. 💙

A leading voice in home-based care policy said something this week that we think deserves attention.

Katie Wehri, VP of Regulatory Affairs at the National Alliance for Care at Home, spoke publicly about CMS's recent clarification that palliative care can be delivered through the Medicare home health benefit. Her take was measured and honest: it's a welcome signal, but it's not a solution.

Home health requires patients to be homebound. Its quality measures are built around improvement and recovery, not comfort and symptom management. And nothing in the benefit requires a home health agency to build out a full interdisciplinary palliative care team — the nurses, social workers, and physicians working together that palliative care actually depends on.
That's not a criticism of home health. It's an honest acknowledgment of what it wasn't designed to do.

This is exactly the gap purpose-built palliative care exists to close — care that isn't bound by a homebound requirement, built around an interdisciplinary team from day one, and focused entirely on quality of life for people managing serious illness.

We're glad to see this conversation getting more precise. The next step is making sure the solutions match the problem.

National Alliance VP: Palliative Care Should Occur Throughout Continuum Palliative care should be offered via home health, but not only through home health.   This is according to Katie Wehri, vice president for

Lung cancer is one diagnosis. But every person who hears it has their own story, their own family, their own values.

Our team walked beside one member from the day she was diagnosed, through treatment, through the hard decision to stop it, and through her transition to hospice care at home.

Her advance directives were complete. Her wishes were clear. Her family was supported.
She was never alone. And that, more than anything, was the gift she said she felt most.

September is World Alzheimer's Month 💜 a global effort to raise awareness of dementia and the millions of families navigating it.

For us, this isn't an abstract observance. Dementia is one of the most common serious illnesses our care teams support. It's also one of the hardest, because it affects not just physical health but memory, communication, and the ability to make your own wishes known.

Our interdisciplinary teams work with patients and families throughout this journey, managing symptoms, supporting caregivers, and helping ensure care stays aligned with what someone actually wanted, even after they can no longer say so themselves.

This month, we're thinking of every family navigating a dementia diagnosis, and every caregiver doing more than anyone realizes.

She called us in tears. Her father was dying. He didn't want to go to the hospital. She didn't know what to do, and without help, another ER trip he'd refused was the most likely outcome.

Our nurse answered. Listened. Acted.

Within hours, hospice was in place. Her father stayed home, in comfort, surrounded by family, exactly where he wanted to be.

In moments like this, what families need most is someone who picks up the phone, hears them, and moves quickly. We're proud to be that team.

Sometimes the wrong diagnosis is the most dangerous symptom of all.

A member living with severe heart failure had been told her tiredness, weight loss, and trouble sleeping were depression. She was prescribed an antidepressant, while the real problem quietly pushed her toward a hospital stay.

She wasn't depressed. Her heart failure was getting worse.

Our team caught it on a routine check-in call. We worked with her doctor. Her treatment got adjusted. She stayed out of the hospital.

The right care starts with really listening.

National Wellness Month continues through August, and we keep coming back to the same question: what does wellness actually mean for someone living with a serious illness?

It's not a step count. It's waking up with less pain. It's a care team that answers the phone when something feels wrong. It's a plan that reflects what a person actually wants, not what the system defaults to.

Palliative care is a wellness intervention. It reduces symptoms. It prevents avoidable crises. It supports the caregivers who are often carrying more than anyone realizes.

And it works best when it starts early, not at a moment of crisis, but from the time a serious illness is diagnosed.

This month, we're grateful for the patients and caregivers who let us walk alongside them, and for the chance to help redefine what wellness can look like even in the hardest chapters.

CMS just introduced a new scoring system for hospices, the Service and Spending Variation Index, or SSVI. It uses nine claims-based measures to evaluate hospice utilization and non-hospice spending patterns.

One industry policy expert called it "a clear message to hospice providers" that bigger changes to the Medicare Hospice Benefit may be coming.

We read it a little differently, as a signal that spending patterns before hospice matter just as much as what happens during it.

That's the entire premise behind community-based palliative care: manage symptoms, coordinate care, and support patients and families well before a serious illness reaches hospice-level acuity. Not to delay hospice when it's needed, but to make sure the months and years before that point aren't defined by avoidable ER visits and fragmented care.

As CMS builds more sophisticated ways to measure spending and utilization across the serious illness journey, we think the evidence will keep pointing the same direction: upstream, coordinated care changes outcomes.

https://hubs.la/Q04tKtPc0

New SSVI System a ‘Matrix’ for Hospice Compliance The newly created service and spending variation index (SSVI) scoring system could challenge hospices’

The monitor said: admit her. She said: no more hospitals.

When her remote cardiac monitor flagged an arrhythmia, the recommendation was immediate hospital admission, likely an ICU stay, likely aggressive intervention, almost certainly not what she wanted.

We were already there. Our nurse in her home. Our provider on a quick virtual visit. A goals-of-care conversation in the moment.

She chose comfort. We honored it. Hospice was in place within 24 hours.

Sometimes the most powerful thing we do is listen and act on what we hear.