Protect the Integrity of the Medicare Hospice Benefit
The Centers for Medicare & Medicaid Services (CMS) plans to test inclusion of hospice under MA as part of the Value-Based Insurance Design (VBID) model program for calendar year 2021. CMS indicated, “This change is designed to increase access to hospice services and facilitate better coordination between patients’ hospice providers and their other clinicians.”
There is widespread concern that this could compromise the integrity of the existing patient-centered, bundled hospice benefit, particularly given Medicare’s current inability – outside of hospice — to measure quality of care at the end of life. Further, there are already changes being tested under MA that may impact end-of-life care, including increased emphasis on advance care planning and provision of palliative care as a supplemental benefit.
In light of these circumstances, rather than testing inclusion of hospice under MA, Congress and the Administration should:
- Closely monitor trends related to advance care planning under VBID and provision of palliative care as a supplemental MA benefit to determine their impact on care choices at the end-of-life
- Develop a robust set of metrics and quality measures related to patient/family satisfaction and care coordination, care transitions, advanced illness and end-of-life care that will allow for comparison across settings in MA and fee-for-service
- Pursue testing of a fee-for-service palliative care model for patients with serious illness based on proposals by the Center to Transform Advanced Care (CTAC)and the American Academy of Hospice and Palliative Care Physicians (AAHPM) to support advanced illness needs and provide a smoother transition to hospice care where appropriate
- Clarify coverage confusion through education of MA plans, hospice providers and patients
