Hospices Ready Themselves for the Medicare Advantage Carve-In

Though hospices remain in the dark about the inner workings of the forthcoming Medicare Advantage carve-in, some are using their knowledge and experience in working with payers to take the first steps toward implementation.

The U.S. Centers for Medicare & Medicaid Services (CMS) earlier this year announced that it would test coverage of hospice care through Medicare Advantage plans beginning in 2021. The carve-in, according to CMS, is intended to increase access to hospice services and facilitate better coordination between patients’ hospice providers and their other clinicians. Reactions to the carve-in demo have been mixed, with many lauding the CMS action and others expressing concern.

Medicare Advantage plans are offered by private insurance companies approved by the U.S. Centers for Medicare & Medicaid Services (CMS), and include HMO, PPO, and fee-for-service plans among other options. The program represents an integrated care model that promotes coordination of services and provides incentives for quality and patient satisfaction. Beginning in 2020, the program will be available in all 50 states as well as U.S. territories.


CMS has revealed very few details about the carve-in thus far, but experts in the hospice field agree that demonstrating that they provide high quality care will be essential to negotiating with Medicare Advantage plans.

“Our first priority has to be quality. We have to make absolutely sure that our performance on quality measures is strong, whether it be CMS Conditions of Participation or [accreditation body] standards or any other publicly reported measures,” Mary Ann Boccolini, president and CEO of Samaritan Healthcare & Hospice, told Hospice News. “[Consumer Assessment of Healthcare Provider and Systems (CAHPS)] scores will be particularly important.”

For hospices, CAHPS surveys are sent to the family after the patient’s death to measure their satisfaction with the care the hospice delivered to their loved one. The survey vendor contacts the family by phone or mail approximately 42 days after the end of the month in which the patient died.


The survey’s 47 questions indicate the family’s perception of hospice performance on 11 metrics such as hospice team communication, symptom management, emotional and spiritual support, patient and caregiver training, and whether the family would recommend the hospice, among other metrics.

Along with a focus on quality, hospices are considering ways to align their services with the other stated purposes of Medicare Advantage: Improving care coordination and reducing health care costs.

“We have been working with [the Center for Medicare & Medicaid Innovation (CMMI)], and their clear intent is to eliminate fragmentation and grow the opportunity for patient’s access to care,” said Tom Koutsoumpus, president and CEO of the National Partnership for Hospice Innovation, at the Senior Care 360 conference in Maryland. “At the end of the day I think the opportunity that they see to streamline is the driving force.”

Many hospices seek to capitalize on the skills they bring to the table by diversifying their service lines, offering patients and eventually Medicare Advantage plans a larger continuum of care.

Providers nationwide are launching palliative care programs, home health care programs, services to address social determinants of health, home-based primary care and a plethora of other offerings designed to care for patients suffering from serious or chronic illness. These services create new revenue streams for the hospice, allow providers to engage with patients earlier in the course of their illnesses, and help ensure seamless transitions to hospice when the patient becomes eligible.

“The overarching opportunity in working with Medicare Advantage plans would really be to increase access to this care. We all know that patients come into hospice too late, and that patients and families have some hesitancy coming onto the service. Timely referrals from physicians and case managers are also an issue,” Boccolini said. “Working with the plans would give us the opportunity to use our distinguishers to drive the redefinition of this care and payment model, eliminating restrictions to care and at the same time providing a level of integration.”

Some stakeholders have theorized that leveraging the hospice model of patient-centered, interdisciplinary care and the associated skill sets could help hospices free themselves from the six-month terminal prognosis restriction on the Medicare Hospice Benefit.

“Medicare Advantage players need to understand how we deliver care and why we are needed and relevant at the end of life, and hospices have to move beyond antiquated views of ‘we have been this way for 30 years and don’t need to change,’” Timothy Ihrig, chief medical officer for Crossroads Hospice & Palliative Care, said at Senior Care 360. “We have the opportunity to come together and hold a dialogue about the ways hospice providers add value and can provide comprehensive care to the seriously ill.”

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