The model immediately began to face problems once it launched and by the end of its first year, 37 hospices, or more than a quarter of those that agreed to participate in the model, exited the effort, according to the report released Wednesday.
Hospices found the $400 payment offered by the CMS to not be enough to cover their costs and they had difficulty finding beneficiaries who met all the eligibility criteria to get treatment under the model. Hospice providers historically have had trouble being properly paid for their services.
Criteria to be covered under this program included beneficiaries not being enrolled in a Medicare managed care organization and participation in a Part D plan. They also needed to be living at home, not in a nursing facility and they had to have had at least two hospital admissions during the prior 12 month period for a set list of diagnoses that included AIDS, heart failure, chronic obstructive pulmonary disease or cancer.
The CMS thought there would be interest in the model given as many as 150,000 patients chose to receive care under the initiative. However, only 5,022 beneficiaries were referred to the program by June 2017 and 60% of those patients turned out not to be eligible to participate. Of the remaining 2,002 patients, 1,092 ultimately chose to enroll.
Hospice staff also encountered physicians who failed to refer patients to the model. The clinicians viewed it as "adding another thing in their to-do list," according to the report.
Low enrollment made it impossible for the CMS to determine if the model slowed Medicare spending in its first year, the report said.
Edo Banach, president and CEO of the not-for-profit National Hospice and Palliative Care Organization said he is still optimistic the model can help seniors in its remaining years. He noted the report indicated that hospice staff in the model was highly satisfied in the program, as were referring providers, enrollees and their families.
"Hospice providers in the model have demonstrated how to provide beneficiaries and their caregivers with a seamless continuum of services through their serious illness and into hospice," Banach said. "With valuable lessons learned, NHPCO is looking forward to working with CMS to build upon [the model] in the years ahead."
Another reason for optimism is that the CMS has gradually reduced eligibility requirements for the program which hospices say will lead to an increased enrollment, according to Liz Fowler, CEO of Bluegrass Care Navigators, a hospice and palliative care agency in Lexington, Ky. that's still involved in the model.
Fowler is convinced patient word of mouth will be positive, given patients and caregivers receive round the clock care management support.
"We often hear people say no one has ever listened to me like this before," Fowler said. "They can call someone at 2 a.m. and talk to someone they know and trust."