Strict policy rules forbid many patients from receiving potentially life-prolonging treatment while enrolled in hospice care. However, researchers have observed that receipt of both — called concurrent care — benefits patients and payers, they said in an article published in JAMA Health Forum.
“Hospice use is increasing over time, but many who could benefit from hospice do not enroll or enroll very late due to current hospice policy in the U.S.,” the special communication said. “The Medicare hospice benefit’s payment structure has typically led to a de facto requirement that patients forgo life-prolonging treatment”
Despite its limited use, concurrent care has proven to be helpful to many groups. Medicaid will pay for hospice care and disease-directed therapies for children, which helps these patients manage their symptoms and improve their quality of life, according to the researchers. The VA Comprehensive End-of-Life Care Initiative also afforded these flexibilities to veterans, which greatly increased hospice enrollment for veterans with certain terminal conditions as well as reduced costs for hospice providers.
The Centers for Medicare & Medicaid Services has experimented with extending concurrent care options for various groups. Earlier this year, CMS extended the Value-Based Insurance Design model, which includes hospice, and will allow certain Medicare Advantage Organizations to offer concurrent care options for people enrolled in hospice.
Delivery of concurrent care is complex, but its need will only become more pronounced as the population of the United States continues to age, the researchers noted. Ongoing efforts to provide concurrent care, such as with CMS’ Kidney Care Choices Model, were found to lower costs of care while improving patients’ health outcomes and quality of life. Concurrent care, they said, presents opportunities to innovate end-of-life care delivery for people with serious or terminal illnesses while benefiting patients and payers.
