St. Luke’s Health System’s hospice will take part in a new pilot program under Medicare.
The Centers for Medicare and Medicaid Services on Monday announced the participants in a new model that it said “empowers beneficiaries, their families and clinicians by providing them with greater flexibility in deciding between hospice care and curative treatment when faced with life-limiting illness.”
St. Luke’s is the only Idaho participant. Other participants in the region are in Oregon and Washington, including Hospice of Spokane.
The “Medicare Care Choices Model” allows beneficiaries who qualify for its hospice benefit to choose to receive the kind of supportive-care services typically provided by hospice as well as continuing to receive “curative” treatments such as chemotherapy.
The program includes people who also qualify for the Medicaid hospice benefit. Hospice care is covered by both Medicare and Medicaid.
Under the current hospice benefit, a patient cannot receive curative care after choosing to start hospice, which provides temporary “palliative care” that is generally provided to people with terminal illnesses or conditions.
“According to March 2015 Medicare Payment Policy Report to the Congress, only 47.3 percent of Medicare and 42 percent of dually eligible [Medicaid and Medicare] beneficiaries used hospice care and most only for a short period of time,” the CMS announcement said. “This data reflects the struggle in having to choose between palliative and curative care during these difficult times.”
The pilot project will evaluate which options patients choose when they don’t have to choose one or the other; and whether providing both services at the same time impacts quality of care as well as patient and family satisfaction.
St. Luke’s and other participating hospices will provide services for routine home care and respite levels of care — such as nursing, social work, hospice homemaking, bereavement and respite-care services — but they must comply with certain billing rules.
Services under this model will be available around the clock, 365 days per year, and the federal Medicare and Medicaid agency will pay monthly fees ranging from $200 to $400 per patient.
The Centers for Medicare and Medicaid Services said it invited more than 140 Medicare-certified hospices to participate in the model for five years, covering a total of about 150,000 Medicare and dual Medicare-and-Medicaid eligible patients.
The patients included in the program are diagnosed with the following terminal illnesses: advanced cancers, chronic obstructive pulmonary disease, congestive heart failure and/or HIV/AIDS. They must be eligible for hospice services and have not elected to receive the Medicare or Medicaid hospice benefit within the 30 days prior to their participation in the new program.
The program will be phased-in over two years, with about half of participating hospices starting to offer services under the model on Jan. 1, 2016, and the rest starting Jan. 1, 2018. The model ends Dec. 31, 2020. Hospices will be randomly assigned to Phase 1 or Phase 2, CMS said.