CMS Expands Pilot of Concurrent Coverage of Hospice, Curative Care
On Monday, CMS announced it will expand a pilot project that allows terminally ill patients to continue receiving curative treatments while also qualifying for hospice coverage through Medicare, Modern Healthcare reports (Evans, Modern Healthcare, 7/20).
The project, called the Medicare Care Choices Model, was established under the Affordable Care Act. According to a CMS fact sheet on the pilot, it will allow "greater beneficiary access to comfort and rehabilitative care in Medicare and Medicaid".
Outside of the initiative, Medicare beneficiaries are required to forgo curative treatments if they choose hospice care.
According to CMS, about 44% of Medicare beneficiaries elect hospice care, with most using the services for a short period of time. However, experts have argued that providing both curative and hospice care improves patients' quality of life. In addition, experts say that offering both services concurrently would not raise health care costs because more patients and their families would choose hospice care if they do not have to give up opportunities for potential life-saving treatments.
Under the pilot, CMS will pay qualifying hospice centers a certain amount per beneficiary per month. Participating suppliers and providers still will "be able to continue to bill Medicare for the reasonable and necessary services they furnish" (CMS fact sheet, 3/18)
According to the Wall Street Journal, CMS originally announced a smaller pilot project that would include 30 hospices, but the agency has not yet begun implementing the initiative (Armour, Wall Street Journal, 7/20).
Pilot Expansion Details
According to CMS, the expanded program will now include 140 hospice providers and run from January 2016 through 2020. One group of hospices will begin the program in January 2016 and a second group will begin the program in January 2018. CMS under the pilot will pay participating providers between $200 and $400 per beneficiary per month to cover hospice patients' care needs. According to Modern Healthcare, the expansion is expected to include about 150,000 terminally ill Medicare beneficiaries who have been diagnosed with:
- Chronic obstructive pulmonary disease;
- Congestive heart failure; and
The types of curative treatments patients are allowed to receive under the program include:
- Medical equipment;
- Physical therapy;
- Physician services;
- Prescription drugs; and
- Short-term hospital stays for pain or symptom management.
CMS will use the initiative to judge whether the program's expanded benefits will lead more patients to enter hospice care, as well as whether it:
- Bolsters patient satisfaction;
- Improves care; and
- Lowers costs (Modern Healthcare, 7/20).
CMS officials have estimated the initiative will either save money or be cost neutral. According to the Journal, the pilot could spur a shift in the way hospice care is delivered if it proves successful (Wall Street Journal, 7/20).
Judi Lund Person, the National Hospice and Palliative Care Organization's regulatory and compliance vice president, called CMS' expansion of the pilot "terrific." She said the program will allow some patients and their families to access curative care services while also receiving care hospices can provide (Modern Healthcare, 7/20).
Bruce Smith, executive medical director of Regence BlueShield, noted many insurers already cover both curative treatments and hospice care at the same time, adding many of the companies believe doing so is best for patients (Wall Street Journal, 7/20).
However, some stakeholders expressed concern the pilot would not be expanded to include skilled and long-term care nursing centers, which often care for many Medicare beneficiaries nearing the ends of their lives.
Lisa Vaden, executive director of the Hospice and Palliative Care Association of Arkansas, said such facilities usually do not have the staff needed to provide intense treatment services at the end of individuals' lives. However, she noted, "The needs of patients dying in these settings are just as acute as other patients, and they are no less deserving of more intensive services during their last week of life" (Young, CQ HealthBeat, 7/20).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.