CMS Testing Curative Along With Palliative Care in Hospice

Megan Brooks

March 24, 2014

The Centers for Medicare & Medicaid Services (CMS) has launched a demonstration project that will allow Medicare beneficiaries who enter hospice to receive potentially life-saving treatment in addition to palliative care.

The Medicare Care Choices Model, which is part of the Affordable Care Act, "empowers clinicians and patients with choices," Patrick Conway, MD, deputy administrator for innovation and quality and CMS chief medical officer, said in a statement. "Specifically, clinicians, family members, and caregivers in this model will no longer need to choose between hospice services and curative care."

At this time, to receive palliative care services offered by hospices, Medicare beneficiaries are required to forgo curative care.

Medicare claims data show that only 44% 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 Medicare Care Choices Model will test whether more Medicare beneficiaries would take advantage of hospice care earlier if they knew they could also get potentially curative treatment in hospice. This could be a new option for Medicare beneficiaries with conditions such as advanced cancers, chronic obstructive pulmonary disease, congestive heart failure, and HIV/AIDS who meet hospice eligibility requirements to now receive both palliative and curative services.

Better Care, Lower Cost

This model is a "win-win," James Tulsky, MD, chief of the Center for Palliative Care at Duke University in Durham, North Carolina, told Medscape Medical News.

"The way the hospice Medicare benefit has been structured," he explained, "it leaves a lot of people who are not ready for an 'all or none' or an 'either or' situation, and in whom there may be value from disease-directed care at the same time that there is also value from hospice services."

Dr. Tulsky thinks the model should provide "better continuity and higher quality of care at lower cost. It will probably help reduce unnecessary hospitalizations for symptom problems and things like that through this kind of care."

"Take for example, the patient who has advanced cancer who is still receiving therapies and [is] therefore not eligible for hospice. In this new program, the patient would be eligible for hospice. When they get pain crisis, instead of running them to the hospital, you'd have a nurse come to the house, assess them, and get them medication. That's actually better for the patient, and obviously it would reduce cost," Dr. Tulsky said.

"This is an important and well-designed initiative that we have been advocating for some time," J. Donald Schumacher, president and chief executive officer of the National Hospice and Palliative Care Organization, told Medscape Medical News.

The end of life is a "sensitive and difficult time for patients and families, filled with confusing and complicated choices. 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," he added in a statement.

The CMS is seeking 30 Medicare-certified and enrolled hospices from around the country to participate in the demonstration project. Participating hospice programs will provide hospice services at the same time patients can receive aggressive therapies.

The CMS will pay $400 per beneficiary per month to participating hospices for palliative services and providers furnishing curative services to these beneficiaries will bill Medicare for their services.

"The question," Dr. Tulsky said, "is can hospices afford this? Is the payment enough to provide the services they will be obligated to provide? I'm hoping that it is doable, and I think that will be figured out in this demonstration project."

Eligible hospice organizations interested in participating in this model must submit an application no later than June 19, 2014.

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