[S]tarting next year, a new federal program will allow many Vermont Medicare recipients to seek hospice care while still receiving curative treatments — an option that is not currently available.
The way things work now, Medicare beneficiaries and dual-eligibles (people receiving Medicare and Medicaid benefits) are required to forgo treatment aimed at recovery in order to be eligible for end-of-life services.
Fewer than half of eligible Medicare beneficiaries use hospice care and most only for a short period of time, according to the federal Centers for Medicare and Medicaid Services. In Vermont, 32 percent of the population uses hospice services as part of end-of-life care, according to figures collected by the Dartmouth Health Atlas. That’s the fifth-lowest rate in the U.S.
Many patients and their families aren’t ready to give up efforts to cure an illness, even if the odds of recovery are low, so it’s hoped that being able to enter hospice while still receiving curative treatments will expand the appeal of the program, said Peter Cobb, executive director of the Vermont Assembly of Home Health and Hospice Agencies.
The current policy leads many people who could benefit from hospice, which combines palliative care and other symptom management with support services to help family members or other caretakers, to delay their entry into hospice care.
The low usage of hospice services in Vermont is troubling, said Judy Peterson, CEO of the Visiting Nurse Association of Chittenden and Grand Isle counties. Last year, her organization and the Madison-Dean Initiative, the VNA’s educational arm, began a study to into whether there are Vermont-specific reasons that people don’t use hospice.
“There are a whole variety of theories, but we want to do this survey to get more validated data and information to better understand it,” Peterson said. They VNA has held focus groups across the state with consumers and other health providers as well as VNA member agencies. It is also collecting information through an online survey.
Peterson said she is hopeful that the new federal program will encourage more Vermont Medicare beneficiaries to take advantage of hospice earlier during an illness.
“So far for the human race, the mortality rate is 100 percent,” Peterson said, but it’s still difficult for many to accept that curative treatment is no longer working. Patients in hospice typically experience better quality of life and sometimes the comfort it offers can help people outlive their prognosis even when they’ve stopped curative treatments, she said, but she recognizes that’s a hard choice for many to make.
“I think what CMS is doing now is recognizing that people still have a difficult time making that decision,” she said, and the federal agency doesn’t want people to hold back because they are still treating an illness.
Participation is limited to beneficiaries with advanced cancers, chronic obstructive pulmonary disease, congestive heart failure and HIV/AIDS. Hospice providers will receive a $200 to $400 per member per month payment for patients who enter hospice through the program.
It’s too early to tell if the payments will cover what hospice services cost, Peterson said. CMS will release greater detail on what services the payments are expected to cover through a series of webinars over the next five months.
Vermont’s nonprofit hospice agencies applied as group to participate in the Choices for Care Model, as the program is known. It’s being run by the CMS Innovation Center, which was created by the Affordable Care Act to accelerate the pace of health reform. The Choices for Care Model was so popular that CMS expanded it from 30 hospice providers to 141 nationwide, and expanded its timeframe from three to five years.
All nine nonprofit hospice providers represented were accepted into the program, and Bayada, a for-profit hospice provider, is also participating. The program is being rolled out in two phases, with all but two agencies starting in 2016.
The Visiting Nurse Association and Hospice of Vermont and New Hampshire and Franklin County Home Health Agency will start in 2018.
