Nurse holding hands with elderly patient.

Two models tested by the Center for Medicare & Medicaid Services Innovation Center (CMMI) show promise in enhancing Medicare’s hospice benefit, according to research firm ATI Advisory. 

In its recent annual report to Congress, CMS reported the Medicare Advantage Value-Based Insurance Design Model (VBID) targeting the chronically ill requires three participating MA plans in 49 states to offer a broader array of services under hospice, including palliative care and concurrent care services. While the ongoing VBID program hasn’t yet generated savings for Medicare, it isn’t costing Medicare additional money.

Meanwhile, the Medicare Care Choices Model (MCCM), which also included 49 hospices, let beneficiaries receive treatment for terminal illnesses while still receiving hospice care. CMS found beneficiaries under MCCM, which ended at the end of 2021, were 26% less likely to be admitted to the hospital which helped lead to a 14% reduction in Medicare expenditures.

The latter findings could be significant for proponents of a hospice benefit that provides palliative care under fee-for-service Medicare plans and continued access to medical care under hospice. ATI Advisory Managing Director Fred Bentley told McKnight’s Home Care Daily Pulse the models provide compelling evidence that “good things” happen when hospices provide support services.

Fred Bentley

“Individuals go to the emergency department less often and are less likely to be hospitalized,” Bentley explained. “There is a really compelling and pressing argument around covering concurrent care even for folks who have elected hospice care.” 

Momentum has been gaining in Washington to improve the hospice benefit. During a meeting last week of the Medicare Payment Advisory Commission (MedPAC), some commission members said they favored a redesign of the hospice benefit to possibly include palliative care and other services. Bentley said there is value in improving the hospice benefit, but it could take time for Congress to agree to potential changes.

“This is not a partisan issue,” he added. “But It is fixing a problem with the Medicare hospice benefit.”

Still, the hospice community is not particularly thrilled with CMS’ potential changes to hospice. Organizations such as the National Association for Home Care & Hospice have voiced concern about payment issues, administration burdens and other problems under VBID.

The hospice benefit under Medicare covers terminally ill patients with a medical prognosis of six months or less to live. Patients must waive all rights to Medicare payments for the terminal illness and related conditions. Palliative care provides medical, spiritual and emotional care for patients with serious illnesses. Traditional Medicare Plan B will only cover some services provided by physicians, nurses and some clinical social workers.

CMS estimated approximately 41.5 million Americans have been impacted by or received care under its 33 innovation models over the past two years. The agency’s biannual report to Congress reviewed models between October 2020 and September 2022.