Medicare Patients May Have More Flexibility Soon
Hospice programs exist to help families when a patient with a terminal illness likely has six months or less to live. The hospice approach neither hastens nor postpones death, but delivers palliative care to manage pain and other symptoms as well as social and spiritual services to increase the quality of life for the patient and the family. Cancer patients are the least likely to experience the full benefits of hospice care because they often enroll in hospice programs very late. One of the reasons for the late enrollment is that chemotherapy is considered aggressive treatment and does not fit in the hospice model, so patients must choose between curative treatment and palliative care.
Less than half of people with Medicare ever use their hospice benefit. Most of those that do use the hospice benefit don’t take advantage of the six months plus of care they could be getting. If their doctors continue to offer hope through aggressive curative treatments, patients are less likely to opt for hospice. We talk about “fighting” disease or “fighting” for our lives, so when a patient or doctor decides to stop aggressive treatments, it may feel as though they are giving up. But what if the fight was for quality of life or the ability to make informed decisions for ourselves? Could there be a balance? Could we offer palliative services earlier to cancer patients and still allow them to try one more round of chemotherapy? Enough people have asked the question that the Centers for Medicare & Medicaid Services (CMS) has agreed to look into it.
The CMS is piloting a new option known as the Medicare Care Choice Model which will allow Medicare beneficiaries to receive palliative services from select hospice providers while continuing other treatments from their doctors. This experimental choice model is being offered through 141 hospices throughout the US in both rural and urban areas. Four hospices in Wisconsin are participating: Agrace, Home Health United, Hospice Alliance, and Unity.
The objective is to see if eligible Medicare patients will elect to receive the palliative services they would normally have to forego while continuing other treatments. For those that do elect palliative services, CMS will study whether or not those individuals experience improved quality of care, better patient and family satisfaction, and how dual services impact Medicare expenditures.
An estimated 150,000 people with terminal illnesses will be able to participate in the five year study. The study isn’t limited to patients with advanced cancers. Patients with other life-limiting illnesses such as chronic obstructive pulmonary disease, congestive heart failure, and human immunodeficiency virus/acquired immunodeficiency syndrome may participate. This means patients who participate in cardiac or pulmonary rehabilitation and meet the eligibility criteria for the new model can continue their rehabilitation and receive palliative care.
It will be interesting to see the results of this study. This may be the first step toward eliminating the line between palliative care and life-sustaining measures that currently seem contradictory. To learn more, visit http://innovation.cms.gov/initiatives/Medicare-Care-Choices/