President Trump’s nominee to replace Tom Price as head of the Department of Health and Human Services (HHS) expressed an interest to overhauling the way Medicare and Medicaid cover end-of-life care. He also praised the role home care can play in efforts to lower health spending through Accountable Care Organizations (ACOs).
While testifying before the Senate Committee on Health, Education, Labor and Pensions on Wednesday, nominee Alex Azar fielded a lengthy question on the topic from Sen. Sheldon Whitehouse. The Rhode Island Democrat expressed frustration at the way government insurance plans cover hospice and other end-of-life services.
“Medicare and Medicaid patients aren’t supposed to receive both hospice care and curative care at the same time,” Whitehouse said. “If you’re seriously focusing on the care of an end-of-life patient, that’s a completely stupid distinction to force into that situation.”
The Senator also called for providing home health coverage even when the patient isn’t necessarily “homebound.”
“Very often, a dying patient can still move around for a while,” Whitehouse said.
Whitehouse sounded off on what he said is an unfairly diminished role for nurse practitioners in end-of-life care, as well as the three-day inpatient stay rule for nursing home residents seeking Medicare coverage—which he called “nonsensical” for patients near the end of their lives. In addition, Whitehouse recommended providing coverage for in-home respite care to ease the burden of familial caregivers, and generally railed against a system he characterized as insufficient for the complicated needs of older patients.
“Here is the government with all of these rules that may make sense in isolation, but once you start to deal with end-of-life care in any kind of a comprehensive and humane fashion, they begin backfiring in your face,” Whitehouse said.
Azar responded by invoking the story of his stepmother, Wilma, who died in July of cancer and was able to stay at home for the duration of her illness.
“I want to make sure people have that chance, and so I’m happy to work with you,” Azar said.
The nominee also seconded Whitehouse’s enthusiasm for accountable care organizations (ACOs) and other alternative payment models, with the senator specifically praising Rhode Island ACOs that have saved Medicare dollars while maintaining quality—and citing the importance of the ACOs’ emphasis on home visits and telehealth.
“If we want to take on the health care cost problem, we’ve got to take it on through entities like these ACOs,” Whitehouse said.
Azar agreed, pledging to work on a bipartisan basis to explore further cost savings and quality improvements through alternative payment models.
“Senator, I would just say amen. Just hearing those stories is exciting to me,” he said of the Rhode Island ACOs.
Azar, formerly a top executive at the Indianapolis-based pharmaceutical giant Eli Lilly & Company (NYSE: LLY), was nominated to replace Tom Price, who resigned in October over an investigation into improper use of taxpayer money on private air travel.
Written by Alex Spanko
