CMS launches hospice demo
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.