MedPAC may recommend Advantage hospice benefit

The Medicare Payment Advisory Commission is considering asking Congress to require Medicare Advantage carriers to cover hospice stays, a significant change to the managed-care plans.

Since the program's inception in 1982, consumers have had to obtain separate Medicare fee-for-service coverage for hospice care. MedPAC staff members told the commission Friday that the separation could be a legacy of a debate at the time about the cost effectiveness of hospice care.

The possible change would come as 14.4 million, or 28%, of Medicare beneficiaries are enrolled in private Medicare Advantage plans, up nearly 10% from 2012, according to the Kaiser Family Foundation. Since 2010, enrollment in Medicare Advantage plans has grown by 30%.

The number of Advantage enrollees electing to get hospice coverage, meanwhile, has grown from 30% in 2000 to 49% in 2011, according to MedPAC data.

The change could mean that Advantage enrollees could continue to get curative treatments when they choose to enter hospice care.

Under Part A, patients must end treatment such as chemotherapy when they begin receiving hospice care. The Patient Protection and Affordable Care Act directed the CMS to test paying for such concurrent care, but the administration has yet to embark on the demonstration project.

MedPAC members appeared to support making the recommendation to Congress.

“From a beneficiary's perspective, this is exactly what they need to move toward a seamless journey,” said Mary Naylor, registered nurse and director of the New Courtland Center for Transitions and Health at the University of Pennsylvania School of Nursing.

“It would make sense to bundle the benefits,” said Scott Armstrong, president and CEO of Group Health Cooperative, a Seattle-based not-for-profit health insurer, referring to patients who wish to continue with treatments that could save their lives.

Some insurance companies may not be thrilled with the change because the status quo means some end-of-life costs are pushed to traditional Medicare, said Donald Taylor, associate professor of community and family medicine and nursing at Duke Medical Center.

One drawback for consumers could be that they would be limited to hospice providers that contract with their plans, which may not be as expansive as the options under Medicare Part A.

But Amy Tucci, president and CEO of the not-for-profit Hospice Foundation of America, said the change would help many more patients get hospice care. “The fact of the matter is, so many people that are eligible for hospice care never get referred, Tucci said. “By incorporating this benefit that could facilitate referral.”