Practice Update
New Medicare Care Choices
Model Seeks to Expand Access
to Palliative Care
n July 20, 2015, the Centers for Medicare
& Medicaid Services (CMS) announced
the 141 hospices that have been selected
to participate in the new Medicare Care
Choices Model (MCCM), a pilot program
designed to expand patients’ access to palliative and hospice care.1 The new model provides clinicians, beneficiaries, and their families with greater flexibility in deciding
between hospice care and active treatment when faced
with life-limiting illnes s.2
Under current payment rules, Medicare and dually
eligible beneficiaries have to forgo active treatment to
receive palliative services under the Medicare or Medicaid Hospice Benefit.
According to the March 2015 Medicare Payment Policy
Report to Congress, only 47.3 percent of Medicare and 42
percent of dually eligible beneficiaries used hospice care
and most only for a short period of time.3
With the MCCM, CMS is addressing this gap in care:
Medicare beneficiaries with certain life-limiting illnesses
can elect to receive supportive hospice or palliative care
services and active treatment concurrently.
“This model empowers clinicians, beneficiaries, and
their families with choices and is part of our broader efforts
to transform our health-care system into one that delivers
better care, makes smarter payments, and puts patients in
the center of their own care,” said Health and Human Services Secretary Sylvia M. Burwell. “We want to do what we can
to help families find the care that is right for their loved one.”
Over the next two years, CMS will evaluate how well
the MCCM increases access to supportive care services
provided by hospice and whether it improves quality of life
and patient/family satisfaction. The model is also designed
to inform new payment systems for the Medicare and
Medicaid programs.
Who Can Participate?
The MCCM will be phased in over two years. Participating hospices will be randomly assigned to phase
one or phase two; services in phase one will start on
January 1, 2016, and on January 1, 2018, for phase two.
Originally, CMS anticipated that only 30 Medicarecertified hospices would be enrolled, and the model
would be installed for only three years. However, “due
to robust interest,” the model was expanded to more
than 140 centers and the duration was extended to five
years, according to a CMS press release announcing
the participating centers.
The selected centers were chosen based on their
responses to a Request for Application issued by CMS in
May 2015. Applications were reviewed and scored by an
expert panel in hospice care and model implementation;
hospices with the highest scores were recommended to be
included in the model.
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ASH Clinical News
The 141 hospices currently participating in the program will provide services available under the Medicare
Hospice Benefit for routine home care and respite levels
of care, but cannot be billed under Medicare Parts A, B,
and D. For a list of the hospice services available under
the MCCM program, see the FIGURE.
FIGURE.
MCCM Services to Beneficiaries
• Satisfaction of hospice eligibility requirements
under the Medicare or Medicaid Hospice Benefit
• Satisfaction of MCCM-specific eligibility criteria
• Have not elected the Medicare or Medicaid Hospice
Benefit within the last 30 days prior to their
participation in the MCCM
Counseling services to the beneficiary and family, including:
-- Bereavement
-- Spiritual
-- Dietary
-- Family support
Beneficiaries will be able to refuse to participate in the
model, and services provided under the model are not
subject to a co-pay.
Psycho-social assessment
Will the MCCM be the turning point for incorporating
palliative care and hospice services into patients’ treatment
plans? It is too soon to tell, but if the MCCM proves successful, it could lead to a shift in the delivery of end-of-life
health care.
Typically, patients obtain hospice and palliative services
only when they are expected to have six months or less to
live; the MCCM model will allow Medicare beneficiaries
who elect to participate to receive these benefits earlier in
their treatment plan.
In addition, the MCCM will potentially eliminate some
of the burden on the health-care system. For instance,
under the traditional hospice benefit, CMS reimburses
approximately $160 per beneficiary, per day for hospice
services – in contrast to the $200 to $400 per-beneficiary,
per-month fee under the new model. The model is also
expected to reduce hospital admissions, emergency department visits, intensive care unit days, and physician office
visits, according to CMS.
There are, however, concerns that the MCCM does not
include skilled and long-term care nursing centers, which
often care for many Medicare beneficiaries nearing the
ends of their lives. Health-care providers who treat older
patients and those with life-limiting illnesses will also need
to be trained in how to discuss these types of services with
the patients and their surrogate decision-makers.
“With passage of the Affordable Care Act, we took
one of the most important steps toward a more accessible
and affordable health-care system in almost 50 years,” Sec.
Burwell said. “With the new tools provided under the law,
we have an opportunity to seize this historic moment to
transform our health-care system into one that works for
the American people.” ●
Nursing services
Medical social services
Hospice aide and homemaker services
Volunteer services
Comprehensive assessment
Plan of care
Interdisciplinary group
Care coordination/case management services
In-home respite care
“This model empowers
clinicians, beneficiaries,
and their families with
choices.”
—SYLVIA M. BURWELL
If the centers provide these services for 15 or more
calendar days per month, they will be paid a fee of $400
per beneficiary per month; if services are provided under
the model for fewer than 15 calendar days per month during the first month that the beneficiary is in the model, the
hospices will be paid a $200 per-beneficiary/per-month fee.
An estimated 150,000 Medicare beneficiaries will be
eligible to receive concurrent hospice and active treatments
as a result of this expansion. Participation is limited to
Medicare beneficiaries who have certain terminal illnesses
(advanced cancers, chronic obstructive pulmonary disease,
congestive heart failure, and human immunodeficiency
virus/acquired immune deficiency syndrome) and meet
the following criteria:
The Future of Palliative and Hospice Care
REFERENCES
1. U.S. Department of Health & Human Services, “CMS announces Medicare Care
Choices Mod el awards.” Accessed October 17, 2015 from http://www.hhs.gov/news/
press/2015pres/07/20150720a.html.
2. CMS.gov, “Medicare Care Choices Model awards.” Accessed October 17, 2015 from www.cms.gov/
Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-07-20.html.
3. Medicare Payment Advisory Commission. “Report to the Congress: Medicare Payment Policy,
March 2015.” Accessed October 17, 2015 from www.medpac.gov/-documents-/reports.
November 2015