The Palliative Care Summit for PeopleFirst Homecare and Hospice was held in Snowbird, Utah on September 15, 2012, following the Rocky Mountain Geriatric Conference. The leadership team in attendance represented over 1400 employees of the PeopleFirst Homecare and Hospice Division of Kindred Healthcare, Inc.  Jim McDonald, Vice President of Western Region for Homecare and Hospice, and Ed Seiler, Senior Director of Hospice and Home Health Operations hosted the summit as a way to bring the western branches together and to give an overview of the BridgePoint Palliative Care program.  There were commanding presentations, sharing ideas and best practices on the implementation and maintenance of a successful palliative care program. You can learn more about PeopleFirst Homecare and Hospice's palliative care program here. 

What is Palliative Care?

  • Specialized medical care for people with serious illness
  • Aims to relieve suffering, improve quality of life, optimize function, and assist with decision-making for patients with advanced illness, and their families
  • The goal is to improve quality of life for both the patient and the family
  • Palliative care is provided by a team of doctors, nurses, and other specialists who work together with a patient's other doctors to provide an extra layer of support
  • It is appropriate at any age and at any stage in a serious illness and can be provided along with curative treatment or as the main focus of care
  • Palliative care can help support the patient care continuum

Palliative Care Summit Brings Together Leaders From Across the Continuum PeopleFirst has realized many advantages to operating a Palliative Care program.   In Denver, 27% of BridgePoint Supportive Care patients have converted to the hospice program in 2012 year to date.  The patients coming to hospice tend to be more stable and have symptoms well-managed.  The Palliative Care team can help facilitate appropriate conversations and becomes a ‘bridge’ between types of care while helping the patient and family navigate through the health care system, including the challenging discussion of hospice.  Jamie Brant, MD from Haven Homecare and Hospice presented “Discussing the Elephant in the Room” which outlines how to facilitate these important and difficult discussions with patients and families.

Kelly Wolf, Division Vice President of PeopleFirst Homecare and Hospice and Lee Ann Bate, Patient Care Coordinator at Haven Homecare and Hospice, explained that introducing Palliative Care is non-threatening and can be marketed as a resource for facilities, as well as a consulting partnership with physicians, as they help design the patient’s care goals.

The Palliative Care team can also assist the Assisted Living facilities in maintaining their census by being another layer of support and can help alleviate the burden on facilities by assisting with MDS [2] requirements and the public reporting of the data.

PeopleFirst has four outpatient Palliative Care programs with plans to open three more over the next few months.  There are many challenges in starting a program because of the relatively new practice and awareness of palliative care and this affects billing.  Homecare and Hospice programs already have clearly defined billing structures in place.  Another challenge faced at each location stems from the differences in state definitions and licensure laws.  As recently as September 2012, the Colorado legislature adopted this definition:

“Palliative Care” means specialized medical care for people with serious illnesses. This type of care is focused on providing patients with relief from the symptoms, pain and stress of serious illness, whatever the diagnosis.

Other states may not as yet have adopted a definition.

Before starting a Palliative Care practice each agency must investigate the state licensure requirements and guidelines.  The agency must be enrolled with CMS as a physician group in order to bill via CMS 855B.[3] Palliative care bills under Evaluation of Management, Medicare B, and coding is critical.  CPT codes describe what was done, ICD codes describe why it was done.  There is much more work needs to be done with insurance companies to smooth out the billing hurdles.

PeopleFirst Homecare and Hospice plans to hold annual meetings among its branches to share information and help facilitate best practices and ideas.

[1] Palliative Care Across the Continuum, Shaida Talebreza MD

Haven HealthCare, University of Utah Division of Geriatrics

[2]National database known as the Minimum Data Set (MDS) - Data for quality measures come from the MDS Repository. The MDS is an assessment done by the nursing home at regular intervals on every resident in a Medicare- or Medicaid-certified nursing home. Information is collected about the resident's health, physical functioning, mental status, and general well-being. These data are used by the nursing home to assess each resident's needs and develop a plan of care.

Post written by:
Tracy R. Hines
Operations Coordinator
PeopleFirst Hospice


Ed SeilerKelly Wolf, Ginger Rogers, Sandra GaldeKelly Wolf and  Lee Ann BateMary Mackenzie, Kelly Wolf, and Sally DeHavenShaida Talebreza, M.D.PeopleFirst Homecare and Hospice Western Region