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CMS to test new hospice payment model

March 19, 2014
by Lois A. Bowers, Senior Editor
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A new payment system to be tested by the Centers for Medicare & Medicaid Services (CMS) would enable Medicare beneficiaries receiving hospice care to receive curative care as well—something they currently must forgo. CMS hopes the demonstration project will determine whether the Medicare Care Choices Model can improve the quality of life and care for beneficiaries, increase their satisfaction and reduce expenses.

"This initiative represents a fundamental change in the way healthcare is delivered," said U.S. Sen. Ron Wyden of Oregon, who authored the provisions that established the model under the Affordable Care Act, in a CMS-issued fact sheet about the initiative. "Patients and their families should have every choice available to them when faced with life-threatening illness. Allowing Medicare coverage to continue while under hospice care means that patients no longer have to make a false choice between hospice and curative care."

CMS plans to test the model over three years with at least 30,000 beneficiaries at 30 or more Medicare-certified and enrolled rural and urban hospices. The federal agency is limiting individual participation to those with advanced cancers, chronic obstructive pulmonary disease, congestive heart failure and HIV/AIDS.

Participating hospices will be paid $400 per beneficiary per month to provide services under the Medicare hospice benefit that cannot be separately billed under Medicare Parts A, B and D. Hospices must provide those services all day, every day.

Providers and suppliers furnishing curative services to beneficiaries participating in the test can continue to bill Medicare for reasonable and necessary services.

Hospices interested in participating must apply by June 19. Programs must have experience in coordination services or case management as well as shared decision-making. Preference will be given to those that can develop, report and analyze quality assurance and performance improvement data.

Choosing hospice

Federal data reveal that, currently, only 44 percent of Medicare beneficiaries use the hospice benefit at the end of life, and most use it for only a short period of time.

"For far too long, the decision to elect hospice has been tantamount to 'giving up' as a patient must decide to forgo what is often thought of as ongoing curative care," J. Donald Schumacher, president and CEO of the National Hospice and Palliative Care Organization, said in a press release from the group. The demonstration project will allow those still seeking "aggressive" curative treatments also to receive "holistic, interdisciplinary care" from the hospice team and will allow family caregivers to receive support from the hospice team as well, he added.