A Novel Billing-Based Approach to Measuring Receipt of Specialty Palliative Care Consultation

Specialty palliative care improves quality of life, symptoms, and goal-concordant care, with greatest benefits when delivered at "full dose" (appropriate timing, intensity, and clinician expertise). Yet access is inequitable, particularly for racial and ethnic minority patients treated at minority-serving institutions (MSIs). Limited methods for identifying palliative care consultations in national datasets hinder progress in studying disparities.

We developed a novel billing-based approach to identify specialty palliative care consultations by linking three data sources from the Mount Sinai Health System (2021-2022): 1) administrative billing data with clinician identifiers, 2) a palliative care consultation registry, and 3) board certification datasets for physicians and nurse practitioners. Consultations were identified using two approaches: clinician National Provider Identifiers (NPIs) flagged for board certification and the ICD-10 Z51.5 code ("Encounter for Palliative Care"). Both were compared against the registry "gold standard."

Board-certified NPIs identified consultations with sensitivity of 64% and specificity of 96%. The Z51.5 code demonstrated high specificity overall (99%) but reduced specificity among patients who died in-hospital (75%) and low sensitivity (∼50%). Many consultations were delivered by non-board-certified clinicians, underscoring limitations of certification-based definitions.

Linking billing, registry, and certification data provides a feasible method for measuring specialty palliative care consultations. However, strict reliance on board certification underestimates care delivered by the workforce, particularly at MSIs. Improved measurement approaches are essential for accurately assessing structural racism in access to palliative care and for guiding equitable workforce and policy interventions.