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

Early integration of specialized palliative care (PC) is recommended by clinical guidelines for advanced-stage cancers, but real-world evidence of its use is limited. We examined the recent trend of early PC billing among Medicare beneficiaries with distant-stage cancers and associated provider- and organization-level factors. Using SEER-Medicare data, we identified Medicare Fee-For-Service beneficiaries 65.5 years and older diagnosed with distant-stage female breast, colorectal, non-small cell lung, small cell lung, pancreatic, or prostate cancers in 2010-2019 with a survival of ≥6 months. Early PC billing was identified by diagnosis codes or hospice and palliative medicine (HPM) specialty codes on outpatient claims within first 3 months of cancer diagnosis or up to hospice admission date, whichever came first. Annual percentages of patients receiving early PC were assessed. We attributed treating physicians and organizations to patients and identified provider- and organization-level factors associated with early PC billing and the between-provider and between-organization variation in early PC billing using multivariable regressions. Among 102,032 patients treated by 18,908 unique physicians, the percentage with early PC billing increased from 1.44% to 10.36% in 2010-2019 (P < .001). Treating physician's early PC referrals in the previous year and organizations' employment of any HPM specialist were associated with 3.01 percentage points (ppts, 95% CI, 2.50 to 3.52) and 4.54 ppts (95% CI, 3.65 to 5.42) higher likelihood of early PC billing. Between-provider variation in early PC was considerable but declined from 51.0% in 2010-2013 to 45.3% in 2017-2019. Similar patterns were found for between-organization variation. Despite growth in early PC billing among patients with distant-stage cancers in 2010-2019, its level remained low. Provider and organizational characteristics such as referral patterns and availability of HPM specialists within the organization may be important drivers for early PC utilization.