New CMS Hospice Program Gives Preference to Data-Savvy Organizations

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Karen Utterback By Karen Utterback 
Former Vice President, Product Marketing and Strategy, McKesson (Retired)
Medicare Care Choices Model

If your hospice agency needed motivation to up its game in terms of reporting and analyzing performance improvement data, CMS has just provided it.

CMS recently announced the Medicare Care Choices Model, which is designed to test whether access to palliative care while continuing with curative care improves quality of care and patient/family satisfaction. It expects to enroll 30,000 beneficiaries during a three-year period.

Hospice eligibility. CMS plans to select at least 30 providers from both rural and urban settings. Providers must be a Medicare-certified and enrolled hospice agency. They must be able to show experience with coordinated services and/or case management and shared decision making to beneficiaries prior to electing the Medicare hospice benefit in conjunction with their referring providers. In addition, CMS plans to give preference to hospices that can demonstrate experience in developing, reporting and analyzing quality assurance and performance improvement data.

Patient eligibility. Patients must have advanced cancer, COPD, CHF or HIV/AIDS. They must meet Medicare hospice eligibility requirements, must not have selected the Medicare hospice benefit within the 30 days prior to their participation in the new model and must have satisfied all of the eligibility criteria (listed in the Benefit Eligibility and Enrollment section of the request for applications). CMS notes that the target population is Medicare beneficiaries who are eligible for the Medicare Hospice Benefit and dual eligible beneficiaries.

Payment model. Hospices will provide services available under the Medicare hospice benefit for routine home care and inpatient respite levels of care that cannot be separately billed under Medicare Parts A, B and D. These services must be available 24/7, 365 days a year. CMS will pay a $400 per-beneficiary-per-month fee to participating hospices.

Deadline. Hospices must submit their application by June 19, 2014.

We’ll be closely following the program as it gets going, as will U.S. Sen. Ron Wyden (D-Ore), who wrote the model’s provisions. “This initiative represents a fundamental change in the way healthcare is delivered,” he said. “Patients and their families should have every choice available to them when faced with life-threatening illness. Allowing Medicare coverage to continue while under hospice care means that patients no longer have to make a choice between hospice and curative care.”

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