CMMI’s Flexible Medicare Hospice Option Shows Promising Results

Nov. 5, 2020
Medicare Care Choices Model saves money by reducing inpatient care through increased use of Medicare hospice benefit

The Center for Medicare & Medicaid Innovation’s Medicare Care Choices Model (MCCM) demonstration led to a 25 percent decrease in total Medicare expenditures, according to a new report.

The model, which started in 2016 and runs through 2021, is designed to allow beneficiaries who qualify for Medicare hospice benefit (MHB) to continue to receive care from other Medicare providers for their terminal condition. (Normally, Medicare beneficiaries who elect to receive hospice care cannot also receive curative treatment for their life-limiting condition. Fewer than half of beneficiaries choose MBH and those that do elect MBH do so less than a week before death.)

MCCM tests whether eligible Medicare and dually eligible beneficiaries would choose to receive hospice support services if they could also continue to receive treatment for their terminal condition. Evaluators are looking at how this flexibility impacts quality of care and satisfaction of the beneficiary, family and caregivers. Under the model, selected hospices furnish support services available under the Medicare hospice benefit that cannot be separately billed under Medicare Parts A, B, and D. These services include nursing, social work, hospice aide, hospice homemaker, volunteer, chaplain, bereavement, nutritional support, and respite care services.

CMS pays a per beneficiary per month (PBPM) fee of $400 to participating hospices for each month a beneficiary is enrolled in the model (except for a reduced fee of $200 in the first month if enrollment is less than 15 days). Providers and suppliers continue to bill Medicare when furnishing reasonable and necessary services covered by Medicare, and not covered by the model. Medicare continues to cover treatment of the beneficiary’s terminal condition.

Three key findings

The executive summary of the report produced for CMMI by Abt Associates and colleagues, listed three key findings:

MCCM led to a 25 percent decrease in total Medicare expenditures, which generated $21.5 million in net savings between January 1, 2016 and September 30, 2019, largely by reducing inpatient care through increased use of MHB by the 3,603 Medicare beneficiaries who enrolled in the model and died during this period.

• Beneficiaries in MCCM elected MHB nearly a week earlier and at a rate that was 20 percentage points higher than the comparison group.

MCCM hospices provided high-quality care to most enrollees, and most caregivers were highly satisfied with the care received through the model and transitions to MHB. At the same time, the documentation of comprehensive assessments and advance care planning discussions varied widely across hospices.

Annie Acs, director of policy and innovation for the National Hospice & Palliative Care Organization, told Hospice News that “The Medicare Care Choices Model is on track to be the sixth CMMI model to show statistically significant savings. The results show that concurrent care, and even an expansion of some of the requirements within MCCM, could make a meaningful difference in both the quality and the cost of end-of-life care.”

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