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New hospice model allows curative therapy to continue

By Randi Belisomo

NEW YORK (Reuters Health) - A new program from the Centers for Medicare and Medicaid Services may remove a barrier that makes patients hesitate to opt for hospice care near the end of life.

Until now, to receive hospice care, patients had to agree to forego any further attempts at curative treatments. The new Medicare Care Choices Model will soon offer an option for Medicare beneficiaries to receive palliative care services from certain hospices while still receiving treatment from curative care providers.

Dr. Eytan Szmuilowicz, a palliative care physician at Northwestern University’s Feinberg School of Medicine in Chicago, told Reuters Health that the new program may ease the burden families face in choosing treatment options.

“Now, we have a problem with patients having to make a choice,” Szmuilowicz said. “It may be based on hope that a treatment will continue to work, even if chances are low. This way, they are not forced to make this choice.”

“There is so much stigma around hospice, and it’s so negative in people’s minds, many can’t bring themselves to try it,” Szmuilowicz added. “If we open the door to help people realize the benefits hospice can bring, it may allow them more time to realize these therapies aren’t helping that much. Maybe that’s a good thing.”

In testing the Medicare Care Choices Model, CMS plans to evaluate whether providing hospice services earlier can improve quality of life among patients and reduce Medicare spending. CMS will limit participation to beneficiaries with advanced cancers, chronic obstructive pulmonary disease, congestive heart failure and HIV/AIDS.

“It’s the right thing to do,” said Shelly Ebbert, director of foundation and external relations at Rainbow Hospice and Palliative Care in Park Ridge, Illinois. Rainbow, serving more than 300 patients daily, is among the Medicare-certified hospice programs applying to participate. Following a June 19th application deadline, CMS will select at least 30 rural and urban hospices to pilot the three year trial; those selected will receive $400 per beneficiary monthly from CMS.

The current daily Medicare reimbursement for home hospice care is roughly $150 per patient. The benefit includes physician services, nursing care, physical and occupational therapy, social services, home health aides, medical supplies and symptom-relieving pharmaceuticals.

“It’s no financial boon to us,” said Ebbert, emphasizing the advantage Rainbow sees in the model is the opportunity to introduce services earlier in a patient’s illness.

Don Schumacher, president of the National Hospice and Palliative Care Organization (NHPCO), said this model may change the future of end-of-life care. “One of the biggest sadnesses and regrets in hospice is that patients are admitted and die within a very short time,” he said, underscoring that too many are not enrolled long enough to realize benefits.

According to the NHPCO, the median length of hospice service in 2011 was 19 days.

One benefit of receiving hospice care sooner might be that symptoms could be addressed before they become difficult to control, said Szmuilowicz. “It’s a lot easier to stay on top of somebody’s pain than catch up to it.”

In the current model, patients no longer see the doctors who’ve been caring for them, as curative therapies are no longer pursued. But as patients pursue curative therapy and hospice support simultaneously, physicians may need to rethink their presentation of this end-of-life option.

“It should be designed as an extension of care patients are getting, rather than an abrupt change to something totally different,” Szmuilowicz said, as shifting care modalities often proves challenging when presented to patients suddenly. An earlier hospice introduction, he said, will allow patients more time to transition to the idea of facing death.

“It’s a lot of work,” Szmuilowicz said of the end of life. “The ideal would be that everybody finds peace with their dying, and that takes time. If we don’t give people that time, we are really robbing them of the potential to find some peace.”

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