The population of seriously ill patients and their caregivers continues to grow. With this expansion of need and care, questions arise about the services provided, challenges faced, and sustainability of community-based of palliative care. Over the summer, the National Hospice and Palliative Care Organization conducted surveys of its membership from forty-eight states. The result is a newly released report titled NHPCO Palliative Care Needs Survey Results.


“The survey provides a snapshot of our members and demonstrates that many are already providing care further upstream from hospice,” says NHPCO Vice President of Palliative and Serious Illness Care Lori Bishop. In fact, 88% of those surveyed say they’re involved in community-based palliative care. This includes 53% of respondents that are already providing palliative care services. Many of those programs providing services are well established, and over 70% have been in existence for more than three years. The remaining 35% of respondents report that they are in the process of developing a palliative care program.


Those surveyed cast a wide net of care that includes many patients. Last year alone, 85,153 seriously ill individuals and their families were served by those responding to the survey. “While the primary location of services provided is community-based (home, assisted living facility, and long-term care), most of these organizations are providing care in multiple settings, including the hospital and clinic,” the report says.


The survey provides insights into the practices of surveyed providers. Most providers are utilizing the NCP Clinical Practice Guidelines for Quality Palliative Care. For the 32% who are “unsure, not familiar, or not following them at all,” the report says the survey “demonstrates an opportunity to expand awareness and educate on the value of the NCP Guidelines.”


The use and composition of NHPCO members’ palliative care interdisciplinary teams also comes into focus. “The bulk of team members [are] directly employed by the organization. Most programs have three or more disciplines on their palliative care team. The most common core team members are physician, nurse practitioner, and social worker, followed by chaplains and registered nurses.” Physicians are most likely to have palliative care certification (67%), followed by nurse practitioners (38%) and registered nurses (38%).


The nature of the teams’ work is tabulated to identify the most common services provided. The report finds a balance of primary services including goals of care discussions, patient or family education, symptom management, comprehensive assessment, advance care planning, care coordination and transition management, medication management, and POST/POLST completion.


NHPCO members also shared reimbursement data. Medicare B fee-for-service billing is the most common reimbursement source by far. Still, “most programs utilize two or more types of reimbursement” including contracts with payers, private pay, philanthropy, Medicare home health, subsidy by parent corporation, grants, and, more rarely, arrangements with an Accountable Care Organization or Medicare Shared Savings Plan.


Electronic medical records are popular, with over 90% of respondents utilizing them. One challenged name was the task NHPCO members face because of the “variety of electronic medical record vendors” and “lack of government incentives to mandate interoperability in the community-based care setting.” Further highlighting the move towards electronic data, 76% of respondents say they collect data for metrics.


The survey was also provided a way to hear about the worries among members. At the top of the list is reimbursement. Specifically mentioned were Medicare B billing and coding, contracting with payers, and collaborating or contracting with ACOs and MSSPs. The lack of understanding of palliative care by referring providers, patients, and families also creates challenges. To a lesser extent, members pointed to measurements and metrics that demonstrate value, obtaining appropriate referrals or an adequate volume. Finally, some members reported staffing challenges including recruitment and retention, productivity, and training and certification.


Taken together, the survey “demonstrates hospice providers are expanding their services to meet the needs of seriously ill individuals and their families, particularly in the community setting,” the report concludes. “NHPCO and the NHPCO Palliative Care Council are committed to developing, (or partnering to provide) tools, resources, and education to support our members in the provision of palliative care services.” (NHPCO, 11/5,; NHPCO, 11/5,