CMS will try offering hospice patients both palliative, curative treatments

The CMS is moving forward with an experiment called for under the 2010 health reform law that will allow Medicare's hospice beneficiaries to get treatments aimed at helping them get better at the same time they get palliative care to help them die as comfortably as possible.

Today, Medicare beneficiaries are required to forgo curative services if they elect hospice care. Experts, however, have argued that providing both forms of care concurrently improves quality of life and won't raise costs because patients and their families are more likely to choose hospice care if it doesn't eliminate opportunities for lifesaving treatments.

The CMS Innovation Center will study these dynamics in a demonstration project announced Tuesday dubbed the Medicare Care Choices Model.

Only 44% of Medicare patients use the hospice benefit at the end of life and most use it for only a short period of time, according to the CMS.

“End of life is a sensitive and difficult time for patients and families, filled with confusing and complicated choices,” J. Donald Schumacher, president and CEO of the National Hospice and Palliative Care Organization, said in a statement praising the CMS' decision. “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.”

Applicants for the program must be a Medicare-certified enrolled hospice that can show a history of providing coordination services and/or case management and shared decisionmaking to beneficiaries before choosing the Medicare hospice benefit together with their referring providers. Meanwhile, hospices that apply and are selected to participate in the model will provide services under the Medicare hospice benefit; the services must be available 24 hours a day, seven days a week throughout the year and cannot be billed separately under Medicare parts A, B and D.

The CMS will pay $400 per beneficiary each month to participating hospices for these services, while providers and suppliers of curative services participating in the program can still bill Medicare for their services.

“This initiative represents a fundamental change in the way healthcare is delivered,” Senate Finance Committee Chairman Ron Wyden (D-Ore.), who wrote the provision of the reform law that authorizes the program, said in a statement. “Patients and their families should have every choice available to them when faced with life-threatening illness. Allowing Medicare coverage to continue while under hospice care means that patients no longer have to make a false choice between hospice and curative care.”

According to the CMS, the target population for this program are Medicare beneficiaries eligible for the hospice benefit as well as dual-eligible beneficiaries who are enrolled in traditional Medicare and are also eligible for the Medicaid hospice benefit. Both sets of beneficiaries must not have chosen either the Medicare or Medicaid hospice benefit within 30 days before participating in the new program. Hospice organizations must apply no later than June 19.

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