(This article was updated at 4:27 p.m. ET.)
Terminally ill patients no longer will have to give up curative treatment to receive Medicare-paid hospice care, under a limited new program the CMS will start testing with 140 hospice providers as early as January.
The Medicare Care Choices Model, established by the Affordable Care Act, waives the requirement that terminally ill patients must end curative treatment such as chemotherapy to qualify for Medicare hospice coverage. The model, which will run through 2020, will test whether the expanded benefits will convince more patients to enter hospice and whether it improves care, enhances patient satisfaction, and reduces costs.
Many rapidly declining patients put off enrolling in hospice until their very last days because they retain hope that curative treatment will work. For the same reason, doctors often hesitate to refer them to hospice.
Experts have argued that offering both palliative and curative 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. Hospice care includes palliative care and respite care to assist family caregivers.
Under the Medicare Care Choices Model, patients can continue to receive curative services such as physical therapy, prescriptions, medical equipment, physician services and short-term hospital visits for pain or symptom management. Instead of getting a per diem payment, hospices will receive a Medicare monthly payment of $200 to $400 per patient for any hospice care that patients need. Meanwhile, other providers will continue to be able to bill Medicare for curative services.
The program will launch in two phases with the first hospices entering in January and a second wave to begin in January 2018. The new initiative is expected to enroll an estimated 150,000 terminally ill patients who have been diagnosed with any of four conditions -- cancer, congestive heart failure, chronic obstructive pulmonary disease and HIV/AIDS. So many hospice providers expressed an interest in participating that the CMS increased the possible roster to 140 hospice providers from the original limit of 30.
That demand underscores the difficult choices that hospices, physicians, patients, and family members are forced to make under Medicare's existing hospice benefit structure, said Melissa Aldridge, an associate professor of geriatrics and palliative medicine at the Icahn School of Medicine at Mount Sinai. Requiring a halt to curative services for patients to receive hospice benefits presents everyone involved with “very black and white dichotomy” even when patients might benefit from both types of care.
Hospice care has evolved in recent decades and more services fall into gray areas that could be considered curative, but Medicare's hospice benefit has not changed to keep up, Aldridge said. Patients potentially delay or refuse hospice services as a result. That leaves patients without assistance, often provided at home, that may prevent crises that force patients to go to the emergency department or hospital, Aldridge said.
Her research on hospice enrollment criteria suggests underuse of hospice services. She noted that one-third of hospice patients were enrolled for one week or less. Experts say many patients and families could benefit from earlier entry into hospice.
More access to hospice care also may save Medicare money, Aldridge said. The model will enable research to determine if that's the case.
Judi Lund Person, regulatory and compliance vice president for the National Hospice and Palliative Care Organization, called the CMS' expansion of the initiative “terrific.” For patients and their families struggling to accept hospice, the model will enable access to those services without foregoing curative services. “For some patients, electing hospice is a difficult thing,” Person said. “It's admitting, 'I'm giving up.' ” Some supportive services may enable patients to make a more gradual transition to hospice.
“This model empowers clinicians, beneficiaries and their families with choices and is part of our broader efforts to transform our healthcare system into one that delivers better care, makes smarter payments and puts patients in the center of their own care,” HHS Secretary Sylvia Mathews Burwell said in a news release. “We want to do what we can to help families find the care that is right for their loved one.”
Last year, the CMS said 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.