Table 1.

Summary of Different Reimbursement Plans and Key Opportunities for Palliative Care Interventions in the ICU

Reimbursement systema	Description	Opportunities for palliative care from the hospital perspective
Fee-for-service	Each service is paid for separately, and payment depends on the quantity of services provided. For example each office visit, laboratory test, or procedure will be paid for separately.	Provided hospital costs are greater than reimbursement, palliative care can have a key role in reducing unwanted intensity of care and corresponding costs.
Bundled payment	Reimbursement is based on an episode of care. The most common example of this is “global surgery periods,” where reimbursement for a particular surgery is bundled–including preoperative, operative, and the postoperative period.	Provided hospital costs are greater than reimbursement, palliative care can have a key role in reducing unwanted intensity of care and corresponding costs.
Hospital value-based purchasing	This program rewards acute care hospitals based on quality of care provided. It factors in adherence to best clinical practices and patients' experiences of care during the admission. Incentive payments to hospitals are determined by performance on selected quality measures and improvements made in quality measures.	Palliative care can have a key role in improving the quality of care delivered.
Capitated payment	Reimbursement based on payment per person, rather than per service provided, irrespective of actual utilization. In this model, each health plan is paid a prospective capitation payment.	Palliative care can have an important role in managing high-cost patients with serious illness and multimorbidity.

^aReference: https://www.cms.gov