Hospice Program with Curative Services to be Tested by CMS

A new Medicare model program will test whether more hospice-eligible beneficiaries will elect to receive those benefits if the beneficiaries will also be allowed to receive curative care services according to an Advance Release published by CMS. The Medicare Care Choices Model will enlist hospice providers to offer curative services for terminally ill patients who qualify for hospice care in an attempt to address data that shows only 44 percent of Medicare beneficiaries are receiving hospice care at the end of their lives. The model will also measure improvements in patient care, patient and family satisfaction with caregiving, and end-of-life quality of life.

Background

The Medicare Care Choices Model was created by the CMS Innovation Center and intends to test whether Medicare beneficiaries who meet Medicare hospice eligibility requirements would elect hospice if they could continue to seek curative services. Although evidence suggests that providing hospice care to terminally ill Medicare beneficiaries can reduce

program expenditures while improving beneficiary satisfaction, only 44 percent of Medicare beneficiaries reach the end of life while using the hospice benefit.  While the average length of stay in hospice has grown, the median length of stay remains at 17 days. According to CMS, many in the hospice industry have suggested that the failure of beneficiaries to take advantage of hospice benefits is due to the requirement that individuals forgo curative treatment when hospice benefits are received. The CMS Innovation Center, created pursuant to the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148), will be managing the study, as it is tasked with testing innovative and creative payment and service delivery models.

Model

The Medicare Care Choices Model will test whether the option to continue to receive curative care has an effect on the number of beneficiaries electing to enroll in hospice benefits. The model, which will collect data over a period of three years, will also examine other potential effects of the program in terms of patient care, patient and family caregiver satisfaction, and quality of life for those new hospice patients. CMS intends to administer this model by requiring hospice centers to coordinate with their network of referring providers by offering curative care to certain beneficiaries who are terminally ill and eligible for hospice benefits. In particular, CMS seeks to enroll traditional Medicare beneficiaries that are suffering from certain types of advanced cancers, HIV, and chronic obstructive pulmonary disease (COPD).

Participating Hospices

Participating hospices will be paid $400 per month per beneficiary for certain hospice support services provided to traditional Medicare fee-for-service beneficiaries. CMS intends to choose approximately 30 providers to participate in the program and will base their selection decisions on whether the providers have demonstrated “experience with care coordination between physicians, hospital, pharmacies, DME suppliers, other suppliers, and skilled nursing facilities.”

How to Apply

To be considered for participation, hospice providers must submit a detailed narrative including the following: (1) the beneficiary population it intends to serve; (2) how it will provide services; (3) in place and planned quality measures; and (4) the number of beneficiaries it expects to serve for each year of the three year model period. Applicants also must submit evidence that shows the hospice’s referring network is capable of identifying beneficiaries that would be eligible for participation in the model program. For more details on the submission requirements and application guidelines visit the CMS Innovation Center’s website.