symptom management) than those used by the primary care provider or other specialists involved in the patient’s care. In pediatrics, however, this revenue stream is difficult to capture without the services of a pediatric hospice or palliative care physician. Some hospitals and acute care institutions allow internal medicine and family practice physicians to see pediatric patients (especially adolescents), which affords pediatric patients the benefit of hospice or palliative care expertise and allows practitioners to bill for their services. However, these patients are then not receiving specialized pediatric care. The likelihood of finding expertise in pediatric palliative care and hospice is currently low and drops even further when patients are not within a hospital setting.

One additional problem in pediatric hospice care is the shortage of contracted beds for symptom control or hospice admissions within acute care settings. In large hospitals, adult hospice programs have little trouble securing a few beds to be used for their patients. In pediatrics, however, hospitals are reluctant to commit beds to hospice care because they may be empty much of the time but could be used for other admissions if available.

• Set a minimum reimbursement rate for physician communication time with parents and with patients. Legislation may be required to prevent denial of payment for this basic service.

• Enforce payment for telephone time and care plan oversight time.

• Enforce reimbursement of team conferences with patients and families at a rate that reflects participation of the multidisciplinary team.

• Develop and test palliative care codes for reimbursement of physicians and other health care providers for pediatric palliative care interventions offered based on the goals of medical care:

  1. Palliative care codes: services offered for patients with incurable disease receiving treatment with the intent to prolong a life of good quality

  2. Hospice care codes: palliative care in which the primary focus of treatment is end-of-life comfort care

  3. Bereavement care codes: palliative care in the form of grief and bereavement counseling for surviving family members

• Develop patient evaluation and management codes for reimbursement of palliative care services in different settings. Include funding mechanisms for the entire multidisciplinary team, including mental health and bereavement workers.

• Create contractual arrangements for a small number of beds in pediatric hospitals to be used for children needing respite or symptom control care, with appropriate reimbursement.