CMS Launches Initiative to Give Hospice Patients Options in Care Type

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By Nathaniel Weixel  

March 19 --Medicare hospice patients will have access to palliative care, as well as care aimed at curing their diseases, under a pilot program announced March 18 by the Centers for Medicare & Medicaid Services.

The Medicare Care Choices Model is mandated by the Affordable Care Act and was championed by Senate Finance Committee Chairman Ron Wyden (D-Ore.), who authored the provision authorizing the program.

According to the CMS, the primary goal of the Medicare Care Choices Model is to test whether beneficiaries who meet Medicare hospice eligibility requirements would elect hospice if they could continue to seek curative services.

“This initiative represents a fundamental change in the way health care is delivered,” Wyden said in a March 18 statement. “Patients and their families should have every choice available to them when faced with life-threatening illness. Allowing Medicare coverage to continue while under hospice care means that patients no longer have to make a false choice between hospice and curative care.”

Currently, Medicare beneficiaries are required to forgo curative care to receive access to palliative care services offered by hospices. The initiative will allow beneficiaries to receive end-of-life care while concurrently receiving curative treatments.

The CMS's Center for Medicare and Medicaid Innovation (CMMI) said it will evaluate whether access to both services can improve the quality of life and care received by Medicare beneficiaries, increase patient satisfaction and reduce Medicare expenditures.

In a March 21 Federal Register notice, the CMS said applications for hospice providers interested in participating in the program are due June 19.

Donald Schumacher, president and chief executive officer of the National Hospice and Palliative Care Organization, praised the new initiative.

“For far too long, the decision to elect hospice has been tantamount to 'giving up' as a patient must decide to forgo what is often thought of as ongoing curative care,” Schumacher said in a March 18 statement. “This new CMMI project will allow Medicare to pilot the innovations that have long benefitted patients in the private market. We trust that the Medicare Care Choices Model project will demonstrate that patients who have access to hospice alongside of curative care have better outcomes, higher family caregiver satisfaction, and benefit from the expert support of hospice earlier in their care.”

Payment, Eligibility Requirements

According to an agency fact sheet, hospices that apply and are selected to participate in the program will provide services available under the Medicare hospice benefit for “routine home care and inpatient respite levels of care that cannot be separately billed under Medicare Parts A, B, and D.”

The CMS said it will pay a $400 per beneficiary per month fee to the Medicare Care Choices Model participating hospices for these services. Providers and suppliers furnishing curative services to beneficiaries participating in the program will be able to continue to bill Medicare “for the reasonable and necessary services they furnish,” the agency said.

Providers interested in applying must be a Medicare certified and enrolled hospice. The CMS said it seeks a diverse group of hospices “representative of various geographic areas, both urban and rural, and hospices of varying sizes. Further, the applicant must be able to demonstrate experience providing coordination services and/or case management, as well as shared decision-making to beneficiaries prior to electing the Medicare hospice benefit in conjunction with their referring providers/suppliers.”

According to the CMS, providing hospice care to terminally ill Medicare beneficiaries can reduce program expenditures while improving beneficiary satisfaction. Yet Medicare claims data show only 44 percent of Medicare patients use the hospice benefit at the end of life, and most use the benefit for only a short period of time, the agency said in the fact sheet.

Although the average length of stay on Medicare hospice has grown over time, the median length of stay has remained stable at about 17 days, the agency said. The hospice industry and other stakeholders often cite the requirement to forgo curative treatment as a primary reason patients don't elect hospice until the final days of their lives, the CMS said.

 

To contact the reporter on this story: Nathaniel Weixel in Washington at nweixel@bna.com

To contact the editor responsible for this story: Ward Pimley at wpimley@bna.com


More information is available at http://innovation.cms.gov/initiatives/Medicare-Care-Choices/.

A fact sheet on the program is at http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2014-Fact-sheets-items/2014-03-18.html.