Although health care policymakers have begun to further open the Medicare Advantage (MA) door, hospice providers remain largely shut out and still looking for a “carve-in.”
But though the hospice industry may be on its own island when it comes to the MA program, it at least appears to be building new bridges.
The National Hospice and Palliative Care Organization (NHPCO) announced Monday that it’s partnering with Better Medicare Alliance (BMA) to help figure out what a possible policy carve-in for hospice under the MA program would look like. Specifically, NHPCO and BMA plan to foster meaningful discussion about potential changes among stakeholders and identify gaps in understanding that need to be more thoroughly researched.
“First and foremost, NHPCO and BMA are partnering to inform our members and allies regarding the opportunities and challenges of a hospice MA carve-in model or proposal,” NHPCO President and CEO Edo Banach told Home Health Care News via email. “There is some debate regarding whether a hospice MA carve-in is inevitable or not.”
Alexandria, Virginia-based NHPCO is the country’s largest not-for-profit membership organization representing hospice and palliative care programs and professionals.
Washington, D.C.-based BMA is a nonprofit advocate coalition of more than 100 ally organizations, including providers, trade associations, aging services groups and health plans. More than 400,000 individual senior advocates focused on strengthening the MA program are also among BMA’s ally members.
“We have several organizations in our coalition who are providers and plans providing palliative care,” Allyson Y. Schwartz, BMA president and CEO, told HHCN via email. “Given our interest in the continuity of care in Medicare Advantage, we think it’s worth it to have this discussion to see what are the opportunities and challenges.”
In general, MA plans are offered by private-sector insurance companies that receive a set amount of money from the federal government to provide Medicare benefits for their beneficiaries. While MA plans cover all Medicare services, most also offer extra coverage, such as vision, hearing and dental coverage.
Companies that offer MA plans have ample leeway in how they manage care, but in theory, they’re incentivized for achieving positive health outcomes and high patient satisfaction. MA has been gaining market share in recent years and has become a more prominent payer for home health companies—many of which also offer hospice. Additionally, recent policy changes have expanded the scope of home care benefits that MA plans are allowed to offer.
Even so, the way the MA program is set up is fragmented for end-of-life care.
Under current policies, MA enrollees who elect hospice remain in their MA plan, but most services end up transferring over to fee-for-service Medicare.
The Medicare Payment Advisory Commission (MedPAC) has long criticized that split as confusing. In at least two separate reports—one in 2014 and another in 2016—MedPAC recommended to Congress that MA plans assume both clinical management and financial responsibility for the hospice benefit.
“We cannot afford to miss an opportunity to bring key stakeholders to the table to discuss the issues and plans hospices may face with a hospice MA carve-in knowing that, ultimately, it’s the care of Medicare beneficiaries and their family caregivers that is paramount,” Banach said.
BMA will bring a familiarity with MA to the partnership, while NHPCO will bring its hospice and palliative care expertise. The goal of the partnership is to create policy that would result in a more robust care continuum extending into palliative care and greater hospice access to patients with advanced illnesses.
Written by Robert Holly