Medicare Leaves Potential Hospice Savings Unexplored

Medicare has yet to launch a concurrent care program that would pay for Medicare beneficiaries to receive joint hospice and curative treatments despite a Congressional directive issued three years ago, Kaiser Health News reports.

Many beneficiaries drag their feet to enroll in a hospice program, preferring to use all available treatment options—something they must agree to forego under Medicare’s hospice benefit—at high cost to the program.

In response, Congress has instructed Medicare and Medicaid to roll out an experimental program that expands hospice services to allow beneficiaries to retain eligibility for curative treatments—a potentially cost saving move.


Kaiser Health News writes:

The 2010 health law required Medicaid to pay for joint hospice and curative treatments, called concurrent care, for children. More than half the states have taken steps to implement that in the joint federal-state program for low-income residents. It also instructed the secretary of Health and Human Services to select up to 15 sites to test concurrent care for patients in Medicare, which provides health coverage to seniors and disabled people. That test is to last for three years, but Medicare has yet to take any concrete steps toward beginning it.

“It is missing an opportunity,” said Dr. Randall Krakauer, an Aetna executive who helped establish that insurer’s concurrent care program for people with private coverage. “Our own experience is when you do liberalize the hospice benefit, it does not cost you extra and it may actually cost you less.”


Krakauer said several years ago, Aetna asked Medicare for permission to expand the program to the 448,000 elderly enrolled in its private Medicare Advantage plans—with Aetna promising to pay for any extra costs — but never got a response. “We are very interested in participating in this,” he said.

Officials at the Center for Medicare & Medicaid Innovation, which is supposed to oversee the project, declined to discuss why the project has not begun or when it would start. “CMS has expressed its commitment to implementing a project that will test new ways of delivering hospice care to Medicare beneficiaries,” the agency said in a written statement. “This demonstration would allow beneficiaries to receive both palliative and curative care at the same time, which could provide better overall care to the patient.”

Participation in Medicare’s hospice benefit has been growing rapidly. The number of Medicare beneficiaries using the hospice benefit doubled to 1.2 million in 2011 from a decade earlier, costing the program about $13.8 billion.

There’s no certainty a concurrent care program would save money for Medicare, but Aetna estimates it saved 22% on people under the age of 65 who were part of its hospice and curative care program, says Kaiser Health News.

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Written by Alyssa Gerace