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Councillors discuss community palliative-care access, reimbursement and long-term care education
Summary
Advisory members and providers described outpatient and home-based palliative programs expanding in the state, insurance and workforce constraints limiting growth, and plans for long-term care education and an interactive resource map; participants proposed conversion-to-hospice and length-of-stay metrics as quality indicators.
Multiple council members and providers reported growing outpatient and home-based palliative-care services, but said reimbursement, workforce capacity and credentialing limit expansion into assisted-living and nursing facilities.
"We have now a fairly robust outpatient palliative care program. We have 1 full time APRN…Our census is now 65, so our APRN is maxed out," said a Connecticut Hospice representative during the meeting. The presenter said insurance contracts, Medicare Advantage and non‑Medicare patients complicate billing and that outpatient palliative care is often not revenue-positive: "You should expect at best to break even and probably to run in the red."
Council members said measuring program impact will be important. Suggested metrics included conversion rate from outpatient palliative care to hospice and length of stay on hospice; one presenter said their program was targeting an 80 percent conversion benchmark and monitoring hospice length of stay to assess earlier access.
Long-term care education and outreach were also discussed. The long-term care ombudsman program is sponsoring a four-part conference series for residential care homes; council members said they will present on palliative-care education there on June 2. Participants urged stronger accountability for facility-level palliative training and discussed developing quality measures for palliative access in facilities.
The council also flagged a supply issue for IV medications at home and asked the Department of Consumer Protection’s drug control office to advise on barriers. One member said vendor reluctance around diversion and misuse was limiting access to IV medications for community palliative patients.
Ending: Council members said they will continue to pursue community palliative-care models, establish clearer metrics to track early hospice referral and share materials from upcoming conferences and research projects.
