Allowing patients to receive concurrent hospice and curative care reduces health care costs and improves quality.
The U.S. Centers for Medicare & Medicaid Services (CMS) has released its fifth and final report on the Medicare Care Choices Model (MCCM), which studied the effects of allowing individuals to receive hospice care without foregoing other treatments.
The agency launched the MCCM in 2016. Initially slated to complete in 2020, CMS later extended it until December 2021. Throughout that period, the model hit every one of its targets — reducing costs, improving quality and family satisfaction, and keeping patients in their homes.
MCCM yielded positive results for every population subgroup that the demonstration examined, according to Keith Kranker, principal researcher for Mathematica and lead author of the CMS evaluation report.
“This model basically worked for everyone we’ve looked at. We really didn’t find subgroups that were not benefiting from the model,” Kranker told Hospice News. “We looked across these different diseases that made people eligible for the model, and for all the diseases finding these kinds of quality improvements and cost savings.”
The model’s 7,263 enrollees were Medicare fee-for-service beneficiaries with a six-month terminal prognosis due to cancer, congestive heart failure, chronic obstructive pulmonary disease, or HIV/AIDS.
These patients had also received a referral to one of the program’s participating hospices, met eligibility criteria for the demonstration and made the choice to enroll in MCCM.
Among patients who had died before the demonstration ended, MCCM reduced Medicare expenditures by $7,604 per enrollee, about a 13% reduction compared to a control group. Hospital admissions dropped 26% and emergency department visits fell by 12%.
Enrolled patients were also more likely to transition to the traditional Medicare Hospice Benefit. MCCM enrollees were 18% more likely to elect the benefit, and their average length of stay reached 42 days compared to 19 for a control group. These patients were also able to stay in their homes longer than non-participants, 183 days compared to 178.
The model also reduced, but did not eliminate, racial and ethnic disparities in hospice utilization.
CMS attributed the savings to earlier hospice admissions and reductions in high-acuity utilization. For some patients, MCCM represented a “gateway” to the traditional benefit, Kranker indicated.
“People are getting this palliative care earlier than they would otherwise. A big takeaway for providers is the benefit of reaching people early, not waiting until the very end,” Kranker said. “There’s so many people that get traditional hospice for like three days or seven days right before they die. In this study, there’s a lot of people getting care quite a bit earlier, and there seems to be benefits to that.”
One limitation of the study was the small number of participating providers. CMS approved 141 hospices to participate in the program, but only 86 admitted a patient to MCCM, and only 44 completed the entire six-year demonstration. Five of those hospices admitted 46% of the patients.
This was largely due to small payments and challenges recruiting beneficiaries, according to the report. Participating hospices received a capitated $400 per-patient, per-month payment.
Due to the small scale, further research is likely needed.
“It’s a really small group of people. They didn’t get the thousands of providers that they might have gotten or the hundreds of thousands of beneficiaries in the model that you might have imagined,” Kranker said. “I think this is a promising policy, but it probably needs continued exploration to see if you can deal with some of those issues that kept the participation in the model limited.”
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