Only about 44 percent of Medicare patients take advantage of their hospice benefit and, for those that do, the average length of stay in hospice is about 67 days; one-third of patients either die or are discharged within one week of admission, according to the National Hospice and Palliative Care Organization.
Through its Medicare Care Choices Model, the Centers for Medicare & Medicaid Services has created a pilot to find out if changes in coverage will encourage more people to take part in hospice care and for longer periods of time.
Currently, Medicare pays benefits for hospice and palliative care treatment for beneficiaries who are determined to have six months to live due to a terminal illness. When a patient chooses hospice care, Medicare pays for hospice benefits and quits paying for curative care related to the terminal illness.
Through the pilot program, Medicare will pay for both curative and hospice care simultaneously for beneficiaries with one of the following conditions: cancer, chronic obstructive pulmonary disease, congestive heart failure or HIV/AIDS. The goal is to see if care is improved and money is saved. Also, to see if the number of patients choosing hospice will be greater if they are allowed benefits for both curative and hospice care.
Hospice providers will be paid a fee of $400 per member per month to provide services that are not normally billed under Medicare. This includes care coordination and patient management. But the extra payment is not going to make a hospice provider rich, said Julia Maroney, RN, senior manager at Simione Healthcare Consultants, LLC.
"This is not a money-making thing for hospice," she said. "It has to be managed well by the hospice or they will lose money – you could eat up $400 with a few visits to the home."
Not all providers are jumping to take part in the program. Maroney said some she has worked with have chosen not to apply for various reasons. Some don't feel they have sufficient staffing to take on care management. Others don't have the scale or connections with nearby hospitals to attract a sufficient number of patients into the program. Medicare has set a goal of enrolling about 30,000 beneficiaries to take part.
But for many, what the program will do is pay money for things they are already doing. Those now offering care management will be able to create a structure and have a payment in place to apply to those services.
Maroney said it will also enable them reach a greater patient population.
"In hospice, you always hear patients and families say, 'If I had only known earlier what hospice could do for us, I would have approached it sooner'," she said. "The goal is to make sure they are reaching a population they couldn't reach before."
It won't be hospice providers, but physicians and hospitals that will be referring patients to the program. Because of this, hospices are going to have to look at the way they recruit patients differently, said Harrison Brown, senior analyst, research and insights at The Advisory Board Company. The model will force hospice providers to create a network of hospitals and physicians that will refer patients earlier to treatment. Brown said hospices will likely be creating tools doctors can use to identify which patients are right for the program.
Another big change, and opportunity, this could bring for hospices is the ability to treat people for much longer periods of time. Instead of working with a patient for two months and while they are very near death, they will be working with patients longer and offering a greater range of services.
"If anything, it will help them stop thinking of themselves just as hospice and instead as a chronic disease provider," Brown said. "They will be coordinating care with a network of providers and working toward recovery … they will have to think of themselves as a disease manager."
Natalie Dawe, senior analyst, research and insights at The Advisory Board Company, said the program will encourage all providers to work together to manage patients. She said she has seen hospitals already partnering with small hospice providers to gain insight into the care and help transition through care settings. Some hospitals have been offering financial and structural support to hospices wanting to take part in care coordination.