A recent study reveals a modest increase in early palliative care (PC) billing among Medicare beneficiaries diagnosed with distant-stage cancers from 2010 to 2019. Despite this upward trend, the overall adoption of early PC remains suboptimal, underscoring the need for targeted interventions at both provider and organizational levels.
The study analyzed data from 102,032 patients aged 65.5 years and older, all diagnosed with distant-stage female breast, colorectal, non–small cell lung, small cell lung, pancreatic, or prostate cancers between 2010 and 2019. These patients, who had a survival of 6 months or more, were treated by 18,908 unique physicians. Early PC billing was identified through diagnosis codes or hospice and palliative medicine (HPM) specialty codes on outpatient claims within the first 3 months of cancer diagnosis or up to the hospice admission date, whichever came first.
Findings indicate that the percentage of patients receiving early PC billing increased from 1.44% in 2010 to 10.36% in 2019 (P < .001). Notably, certain provider and organizational characteristics significantly influenced early PC billing rates. Patients whose treating physicians had a history of early PC referrals in the previous year were 3.01 percentage points more likely to receive early PC billing (95% CI, 2.50 to 3.52). Additionally, organizations employing at least one HPM specialist saw a 4.54 percentage point increase in early PC billing likelihood among their patients (95% CI, 3.65 to 5.42). The study also highlighted considerable variation in early PC billing practices among providers and organizations. Between-provider variation decreased from 51.0% in the 2010-2013 period to 45.3% in 2017-2019, suggesting a gradual alignment in practices. Similar patterns were observed at the organizational level, indicating that while progress has been made, significant disparities persist. These findings emphasize the critical role of individual provider practices and organizational resources in the early integration of palliative care. The association between a physician's prior referral patterns and the employment of HPM specialists within an organization with higher early PC billing rates suggests that targeted strategies focusing on these factors could enhance early PC utilization. Despite the observed growth in early PC billing over the decade, the overall rates remain low. This underscores the necessity for continued efforts to promote early palliative care integration, ensuring that patients with advanced-stage cancers receive comprehensive care that addresses both their medical and quality-of-life needs. Reference: Hu X et al. Trend and Provider- and Organizational-Level Factors Associated With Early Palliative Care Billing Among Patients Diagnosed With Distant-Stage Cancers in 2010-2019 in the United States. JCO. doi:10.1200/JCO-24-01935. Anaya Malik | AMJ
