Medicare

How the Hospice Benefit Could Be Redefined

Published in Home Health Care News By Amy Baxter

As recent changes across the health care system over the last few years indicate that person-centered, interdisciplinary care can improve clinical outcomes, boost patient satisfaction and potentially lower overall costs, hospice care could see an evolution ahead.

Hospice has become known as the first truly interdisciplinary benefit, bringing together many types of care under one roof. As more alternative payment models (APMs), managed care organizations and Medicare Advantage plans seek more flexibility in caring for patients with a person-centered approach, hospice is similarly looking for a way into these increasingly popular care models.

Home Health Care News caught up with Edo Banach, CEO of the National Hospice and Palliative Care Organization (NHPCO), to discover how the association is helping push the boundaries of hospice care with a new advertising campaign aimed at consumers and lawmakers, and efforts to redefine the benefit. Banach, who has been at the helm of NHPCO for more than a year, has an extensive background of working closely with the regulations and innovations departments at the Centers for Medicare & Medicaid Services (CMS) before the hospice industry “came calling.”

Here’s where Banach believes hospice is going.

Overall, what are the biggest changes you’ve seen during your career in health care?

Banach: One thing that is positive is when I started working in health care 16 years ago, it was really hard. What I’ve seen is, back then, managed care companies weren’t falling all over themselves to manage coordinated care. You had a really more siloed system than you have now, pre-Affordable Care Act (ACA), pre-[Medicare] Part D.

Managed care companies can now pay for less medical benefits [by supplementing with non-medical benefits]. We’re getting more integrated. We are moving in the right direction. I want to make sure that the integration and technology is used as a tool to help supplement real, compassionate interdisciplinary care, not one-step-removed care.

So, you talk about hospice being a movement. Where do you see hospice moving to?

One way we see it moving is upstream, but it is an absolute shame that people have to give up so-called curative care in order to get palliative care, hospice. It shouldn’t be a choice. You should be able to get both.

I think when people get both, they often see the value of palliative care. There is a demonstration now called the Care Choices model, which is testing out if curative and palliative care saves money or not, [if it] is an improvement on quality or not, and that will be very helpful and telling.

My goal in the next couple years, if not the next couple months, is to create a pre-hospice palliative care benefit that will allow folks to benefit from person-centered interdisciplinary care, that you see in hospice, earlier. When they have a serious illness, [palliative care is] a pathway and a glide path to receive the full-on hospice benefit that they will eventually receive.

Most people are on hospice now for only a couple of weeks, if not a couple days.

Just like former First Lady Barbara Bush.

Yes, she took comfort care and passed away two days later. And I think that’s not enough time for the system of care to actually have the impact that it needs to have.

Part of it is the choice that people make. Do you want curative care or do you want palliative care? You should be able to get both, and I think that’s crucial. That’s something that we will get to.

What are your other top priorities?

The other thing is about the length [of stay]. The problem with Medicare fee-for-service [FFS] now is these black lines—if you’re on one side, it is OK, and on the other side it’s not. For home health it’s skilled, homebound, these are the things we talk about and auditors look at a lot. In hospice, it’s [about if] you have a prognosis of less than six months and a need for hospice care.

That six-month limitation is treated as a clinical issue. It’s not a clinical issue; it’s a budgetary issue. It doesn’t make sense anymore. Ideally, in a couple years we will have much more of a glide-path between [when a person is] going along swimmingly and getting whatever is medically necessary under Medicare and receiving interdisciplinary person-centered care under hospice.

And my hope is that interdisciplinary person-centered care actually becomes the rule rather than the exception. That’s how this movement will have worked. I don’t just want to reshape the hospice benefit, I want to reshape health care.

Seems like a big uphill battle to me, as new Medicare benefits really come along quite infrequently.

Yes and no. For this, it’s not actually as radical as it sounds. This is an APM that I expect will actually happen. There’s interest in it, we’ve had meetings about it. I am hopeful this is something that can be done.

You’re right, Medicare benefits come infrequently. But we are not talking about a new benefit here. We’re talking about flexibility to provide more person-centered care that is not the poked-and-prodded variety. And that’s exactly what is happening over at ACOs and in Medicare Advantage land. As that is happening and plans can now pay for supports and services, it will seem even less logical for FFS Medicare to be in this box. So I think it is imminent.

 

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Waiting Rooms Encouraged to Show Video with New Medicare Cards

Click for new video featuring the replacement IDs

Originally published in AARP’s Health Medicare Resource Center By Dena Bunis, AARP, March 2018

Medicare is asking doctors to play a new video in their waiting rooms to remind patients that the federal government will begin mailing them new identification cards next month.

The video gives beneficiaries a glimpse at what the new card will look like and explains why and how it was modified. Instead of a Social Security number, the cards will display an 11-digit Medicare beneficiary identifier, and they will no longer include gender and a signature.

Eliminating the personal details, Centers for Medicare and Medicaid Services (CMS) officials say, will better protect an enrollee’s identity and guard against fraud.

The Social Security Administration (SSA) urges Medicare enrollees to make sure the agency has their correct address on file. You can go to socialsecurity.gov/myaccount or call 800-772-1213 to update your address.

Scammers with various ploys have already started to target the 58 million individuals who will be getting new cards. The Federal Trade Commission (FTC) reports that con artists are calling beneficiaries and pretending to be from Medicare, then trying to talk them into paying for the revised card. Medicare will never call and ask for any personal identification or money for the new cards. The cards are free and will be mailed to members’ homes.

Medicare beneficiaries in Delaware, the District of Columbia, Maryland, Pennsylvania, Virginia and West Virginia will be the first enrollees to receive the replacement cards. The mailings will continue through 2019.

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Paying For End-of-Life Care

Baby Boomers Feel the Squeeze

Man Paying Bills

Concerns over the costs of healthcare are shared by almost every family across the country. Many baby boomers are providing care for their aging parents just as they are facing their own health care issues.

Yet, for almost 30 years, the Medicare Hospice Benefit has provided a model for financing end-of-life care that can bring great relief and support to families during one of life’s most difficult times.

This benefit covers virtually all aspects of hospice care with little out-of-pocket expense to the patient or family. As a result, the financial burdens often associated with caring for a terminally-ill patient are lifted.

Hospice care also offers supports to the loved ones of the patient; this brings an added level of relief to the dying person, knowing their loved ones are being cared for as well.

Hospice is paid for through the Medicare Hospice Benefit, Medicaid Hospice Benefit, and most private insurers.

Medicare covers these hospice services and pays nearly all of their costs:

Medicare will still pay for covered benefits for any health problems that aren’t related to a terminal illness.

Hospice Means More Medical Care, Not LessTeam of medical professionals

Hospice and palliative care involves a team-oriented approach to expert medical care, pain management, and emotional and spiritual support expressly tailored to the patient’s needs and wishes. Families making end-of-life decisions for a loved one need compassion and support, not financial worries. The Medicare Hospice Benefit helps alleviate these concerns.

To learn more, contact Houston Hospice at 281-468-2441 or 800-824-2911 or at info@houstonhospice.org.

To find a hospice or learn more about hospice care, visit Moments of Life at www.MomentsOfLife.org.

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