Medicare Care Choices Model Awards Drive Choice, Quality
By - The Centers for Medicare & Medicaid Services (CMS) is focused on helping Medicare beneficiaries, their families, and loved ones acquire the right type of healthcare. This week, CMS announced the 141 urban and rural hospices selected to participate in the Medicare Care Choices Model.
What is the Medicare Care Choices Model?
According to CMS, the Medicare Care Choices Model assesses whether or not both eligible Medicare and dually eligible beneficiaries will choose to accept generally provided hospice supportive care services along with curative services. The Model additionally examines the effect of a simultaneous offering of both palliative and curative care on care quality and patient and family satisfaction.
“Under the model, participating hospices will provide services that are currently available under the Medicare hospice benefit for routine home care and respite levels of care, but cannot be separately billed under Medicare Parts A, B, and D,” says CMS. Such services include nursing, social work, hospice aide, respite care services, and others. “CMS originally anticipated selecting at least 30 Medicare-certified hospices to participate in the model and enrolling up to 30,000 beneficiaries throughout a 3-year period. Due to robust interest, CMS has invited over 140 Medicare-certified hospices to participate in the model and expanded the duration of the model to 5 years,” CMS explains, anticipating future participation for up to 150,000 eligible Medicare and dually eligible beneficiaries.
Delivery of services under the Medicare Choices Model will be implemented over the course of 2 years, says CMS. Half of participating hospices will start providing services under the model this January. CMS confirms it will pay a beneficiary a monthly $200 - $400 fee to participating hospices that deliver services via the Medicare Choices Model.
Healthcare providers and suppliers furnishing curative services will bill Medicare for the reasonable and necessary services furnished to beneficiaries who elect to participate in the model, says CMS. Such services include physical or occupational therapy, speech language pathology services, pain management drugs, and medical equipment and supplies.
Is this model a truly monumental healthcare moment?
When a patient, his or her loved ones, and/or family is faced with the difficult decision of choosing between palliative and curative care, this likely complicates and exacerbates the ability to receive high quality care. What are the greater implications of the Medicare Choices Model?
For one thing, the model may collectively advance the healthcare system by eliminating burden. “Many seniors, disabled Americans, and family members of individuals who suffer from life limiting illnesses must choose between the support services provided through hospice care or curative treatment,” states a press release from the Department of Health and Human Services (HHS). “With passage of the Affordable Care Act, we took one of the most important steps toward a more accessible and affordable health care system in almost 50 years. With the new tools provided under the law, we have an opportunity to seize this historic moment to transform our health care system into one that works for the American people,” HHS confirms.
CMS additionally confirms the model improves quality of life with a trifold primary objective to increase access to supportive care services provided by hospice, enhance patient and family satisfaction, and inform new payment systems for the Medicare and Medicaid programs.
The model may also promote efficiency. Currently implemented Medicare payment rules do not allow individuals to simultaneously receive palliative and curative treatment, says HHS. Less than half of eligible Medicare beneficiaries use hospice care, HHS notes; most only utilize it for a brief window of time.
Lastly, the model appears to be a powerful step in the right direction to promote smart, quality care. “This model empowers clinicians, beneficiaries and their families with choices and is part of our broader efforts to transform our health care system into one that delivers better care, makes smarter payments, and puts patients in the center of their own care,” comments Sylvia M. Burwell, HHS Secretary. “We want to do what we can to help families find the care that is right for their loved one,” she adds.
