CMS pilots program for joint hospice/curative care

The Centers for Medicare & Medicaid Services (CMS) is launching a new pilot program to examine an idea: Perhaps hospice care and curative care shouldn’t be viewed as mutually exclusive.

Hospice care is covered by Medicare and Medicaid for eligible beneficiaries who have a life expectancy of six months or less. However, in most cases, those who choose to use Medicare or Medicaid benefits for hospice and palliative services are no longer eligible to receive conventional curative care. The Medicare Care Choice Model pilot is designed to examine whether beneficiaries would choose to use hospice services earlier if they were not required to give up curative care services, and if the simultaneous delivery of curative and palliative care services would increase quality of life while easing care burdens for families.

The program, originally envisioned as a 30-site trial, quickly expanded to 140 hospice sites among 10 regions and some 150,000 eligible beneficiaries, due to overwhelming participation interest. Under the model, participating hospices will receive reimbursements of $200–400 per beneficiary, while curative care providers also will be able to bill for “reasonable and necessary” curative services, according to a CMS factsheet on the program.

Being forced to choose between hospice and curative care can create undue stress may cause patients to delay seeking important palliative services. Less than half of eligible Medicare beneficiaries use hospice care, and most of them waited until the last minute, noted a March 2015 MedPAC report to Congress.

The CMS joint-care model will begin a two-year phase-in schedule beginning in 2016 and will end in 2020.

See the list of participants (as of July 2015) here.

Topics: Executive Leadership , Medicare/Medicaid , Regulatory Compliance