CMS launches hos­pice demo

Modern Healthcare - - NEWS - By Vir­gil Dick­son

To en­cour­age more Medi­care pa­tients to en­roll in hos­pice, physi­cians and hos­pices gen­er­ally are sup­port­ing a CMS ex­per­i­ment al­low­ing ter­mi­nally ill Medi­care ben­e­fi­cia­ries to con­tinue cu­ra­tive treat­ment while start­ing hos­pice ser­vices. But pa­tient ad­vo­cates say the demon­stra­tion should be struc­tured to per­mit pa­tients who still have hope for re­cov­ery to en­ter the pro­gram.

The demon­stra­tion comes in the midst of a pol­icy quandary: While ex­perts long have said that too few dy­ing Amer­i­cans take ad­van­tage of hos­pice ser­vices, Medi­care costs for hos­pice have risen sig­nif­i­cantly in re­cent years as fed­eral rules have eased and more for-profit op­er­a­tors have en­tered the sec­tor.

Medi­care pa­tients cur­rently are re­quired to forgo cu­ra­tive ser­vices when they en­roll in a hos­pice pro­gram, which pro­vides pal­lia­tive care to make them more com­fort­able dur­ing the dy­ing process. But stud­ies have found that pro­vid­ing both forms of care con­cur­rently im­proves qual­ity of life and re­duces costs be­cause it leads more peo­ple to elect hos­pice in­stead of mak­ing fre­quent hospi­tal vis­its.

Un­der the demon­stra­tion, au­tho­rized by the Pa­tient Pro­tec­tion and Af­ford­able Care Act, the CMS will pay a se­lect group of hos­pices $400 per ben­e­fi­ciary per month for pal­lia- tive ser­vices for pa­tients who are ex­pected to live six months or less; providers and sup­pli­ers of cu­ra­tive ser­vices still could bill Medi­care for their ser­vices. Hos­pice or­ga­ni­za­tions must ap­ply for the demon­stra­tion by June 19.

The project holds prom­ise, said Dr. Amy Kel­ley, as­sis­tant pro­fes­sor of geri­atrics and pal­lia­tive medicine at Mount Si­nai Hospi­tal, New York. Last year, she co-au­thored a study in Health Af­fairs that found hos­pice pa­tients had much lower rates of hospi­tal and in­ten­sive-care use, read­mis­sions and in­hos­pi­tal death when com­pared with pa­tients not in hos­pice.

The demon­stra­tion also could in­crease co­or­di­na­tion be­tween physi­cians, other cu­ra­tive providers and hos­pices, said Theresa Forster, vice pres­i­dent for hos­pice pol­icy and pro­grams of the Na­tional Coun­cil on Med­i­caid Home Care, an ad­vo­cacy group af­fil­i­ated with the Na­tional As­so­ci­a­tion for Home Care & Hos­pice.

But Terry Berth­elot, a se­nior at­tor­ney at the Cen­ter for Medi­care Ad­vo­cacy, said the demon­stra­tion’s im­pact would be greater if it were open to pa­tients fight­ing lifethreat­en­ing ill­nesses yet still not at the point of run­ning out of cu­ra­tive op­tions. It should not be lim­ited to pa­tients with six months or less to live, Berth­elot said.

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