A better Hospice model for Medicare choices


By Barbara Mancini and Mark Dann



The father-in-law of one of our colleagues passed away six months ago from stomach cancer. He spent the last four months of his life in and out of the hospital getting surgeries and various tests and treatments that only caused him great pain and suffering. By the time the doctors finally told him he was terminal, he only had a week to live.

Almost every day at the end-of-life care organization we work for, Compassion & Choices, we hear a story like this one from our 450,000 supporters or read a study about the dismal shape of end-of-life care and we think: There has to be a better way.

Many terminally ill people with a terminal prognosis of six months or less to live choose to go into hospice. According to the National Hospice and Palliative Care Organization, hospice is specialized care for those facing a life-limiting illness and for their families and caregivers.

High quality hospice care can be wonderful because it focuses on palliative care to maximize comfort and minimize suffering at the end of life. There is access to an interdisciplinary team that caters to the physical, social and the spiritual well-being of the dying person.

And yet, at the core of hospice care is a paradox. People who elect hospice must choose between palliative care and support services or curative treatment hospice that does not provide. Fewer than half of eligible Medicare beneficiaries use hospice care and most do so only for the last few days of their lives. As a result, they get minimal benefit from hospice because there is not enough time to evaluate their needs.

Medicare beneficiaries currently are not eligible to receive concurrent palliative and curative treatments. The result is that we are all too familiar with stories of people who enroll in hospice only after the conclusion of long bouts of aggressive, excruciating treatment because they and/or their doctors did not want to give up on curative treatment. Who can blame them?

There is a better way. In January, Medicare expanded a pilot project in which Medicare beneficiaries can receive hospice care AND concurrent curative therapies at over 140 test sites in 39 states (the map and list of test site locations is posted at: innovation.cms.gov/initiatives/map/index.html#model=medicare-care-choices-model). It’s called the Medicare Choices Model.

Medicare anticipates that 150,000 eligible beneficiaries with advanced cancers, Chronic Obstructive Pulmonary Disease, congestive heart failure and HIV/AIDS will participate. That is great news. Unfortunately, Modern Healthcare recently reported, “only a third of hospice-eligible beneficiaries have one of these diagnoses, according to the most recent Medicare hospice data.”

This model would have freed the doctors treating our colleague’s father-in-law to advise him when they first diagnosed his cancer that he was terminal and eligible for hospice care without stopping curative treatment.

Compassion & Choices has consistently advocated for this type of innovative project as part of our federal policy agenda to reform the end-of-life health care system to make it more patient-centered.

We believe that patients and families should know the costs and benefits of all treatments at the end of life. The Medicare Choices Model now makes that goal easier.

“There are now several studies that show that patients who receive both palliative care and life-prolonging care actually live longer than those who receive life-prolonging treatment alone,” says Dr. Diane Meier, director of the Center to Advance Palliative Care. “It makes sense. People aren’t in excruciating pain, they’re not depressed and their families feel confident in their ability to care for their loved one.”

The Medicare Choices Model pilot program runs through 2020. We hope the Centers for Medicare and Medicaid adopt recommendations by Compassion & Choices and other health care advocacy organizations to expand participation to Medicare beneficiaries with other life-threatening conditions and make this model permanent.

Barbara Mancini, a consultant for Compassion & Choices, was an ER nurse for more than 20 years at Lankenau Medical Center in Wynnewood, Pa. Mark Dann is federal affairs director for Compassion & Choices. This oped originally was published by the Pittsburgh Post-Gazette and is courtesy of American Forum.

By Barbara Mancini and Mark Dann

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