The U.S. Centers for Medicare and Medicaid Services (CMS) Medicare Care Choices Model (MCCM) demonstration has reduced the agency’s costs by $26 million to date. The demonstration, established in 2016 and scheduled to end in June 2021, is designed to test the efficacy and efficiency of providing hospice concurrent with curative care.
CMS announced the savings in a recent MCCM annual report. The agency attributed most of the savings to associated reductions in acute care utilization. The report also found that more MCCM patients elected the Medicare Hospice Benefit than their counterparts outside of the program. The MCCM participants tended to enter hospice earlier by about a week on average.
“The Medicare Care Choices Model is on track to be the sixth [Center for Medicare & Medicaid Innovation (CMMI)] model to show statistically significant savings,” said Annie Acs, director of policy and innovation for the National Hospice & Palliative Care Organization (NHPCO). “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.”
The program produced gross Medicare savings during the last 90 days of life amounting to $9,874 per decedent, representing a 25% reduction in spending compared to a group of similar beneficiaries residing in MCCM hospice markets during the baseline period. Savings during the last 30 days of life totaled $8,014 per decedent, a 40% smaller spend.
The model allows participating hospices to provide routine home care and at-home respite care that are currently available under the Medicare hospice benefit, but cannot be separately billed through Medicare Parts A, B, and D while enrollees are also pursuing curative treatments. CMS typically pays participants $400 per patient, per month while they are delivering services under the model, including care coordination, case management, symptom management, and other support for beneficiaries and families.
Through the model demonstration, CMS is assessing whether concurrent care can improve the quality of life and care of hospice patients covered by Medicare, boost patient satisfaction, and cut the agency’s costs. Federal law allows CMMI to test innovative payment and service delivery models that have the potential to reduce Medicare, Medicaid or Children’s Health Insurance Program (CHIP) expenditures, while maintaining or improving the quality of care for Medicare beneficiaries.
“This is a co-management model.We would like to have concurrent care included as a benefit, because we do see that it has helped make the program more successful for both the patients and the caregivers,” Acs told Hospice News. “We would like it to be a seamless continuum of care.”
The program was initially set to include 30 providers, but CMS expanded the parameters to allow for 140 participants due to widespread interest. According to the agency, 82 hospices are participating in the demonstration as of June 2020.
To qualify for the program, Medicare beneficiaries must have been enrolled in Medicare fee-for-service as their primary insurance for at least 12 months and have a terminal prognosis or six months or less.
Only patients with a diagnosis of cancer, congestive heart failure, chronic obstructive pulmonary disease or HIV/AIDS are eligible, if they have had at least one hospital encounter during the last 12 months and had at least three office visits with any Medicare provider within the previous 12 months. Eligible patients must live in a private residence, as opposed to a nursing home or assisted living, and they must reside in the service area of a participating hospice.
Stakeholders in the hospice space have called on CMS to remove some of these criteria if a permanent model or second-generation demonstration were to occur, such as allowing patients with other diagnoses to participate.
“NHPCO and the [National Coalition for Hospice and Palliative Care] would really like to launch a second-generation Medicare Care Choices model. We feel that CMS could take the positive results that they have seen within this model and expand it to test community-based palliative care,” Acs said. “We would like to increase the number of diagnoses that would be included in those eligibility requirements. The big one is removing the six-month prognosis requirement. The evaluation findings did suggest that individuals with serious illness and their caregivers would benefit from supportive care earlier in the disease trajectory.”