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Hospice plus treatment

Medicare should cover palliative and curative measures for terminal patients

Today, the Pittsburgh-Post Gazette ran a piece by Barbara Mancini and Mark Dann, Compassion & Choices’ Federal Affairs Director. The two argue that even though hospice care is often high-quality, Medicare beneficiaries are forced to make a choice between palliative hospice care and curable treatments:

High quality hospice care can be wonderful because it focuses on palliative care to maximize comfort and minimize suffering at the end of life. There is access to an interdisciplinary team that caters to the physical, social and the spiritual well-being of the dying person.

And yet, at the core of hospice care is a paradox. People who elect hospice now must choose between palliative care with support services or curative treatment that hospice does not provide. Fewer than half of eligible Medicare beneficiaries use hospice care and most do so only for the last few days of their lives. As a result, they get minimal benefit from hospice because there is not enough time to evaluate their needs.

Medicare beneficiaries currently are not eligible to receive concurrent palliative and curative treatments. The result is that we are all too familiar with stories of people who enroll in hospice only after the conclusion of long bouts of aggressive, excruciating treatment because they and/​or their doctors did not want to give up on curative treatment. Who can blame them?

There is a better way. In January, Medicare expanded a pilot project in which Medicare beneficiaries can receive hospice care and concurrent curative therapies at up to 140 test sites around the country, including the Jewish Association on Aging in Pittsburgh. It’s called the Medicare Choices Model.

Medicare anticipates that 150,000 eligible beneficiaries with advanced cancers, Chronic Obstructive Pulmonary Disease, congestive heart failure and HIV/​AIDS will participate. That is great news. Unfortunately, Modern Healthcare recently reported, “only a third of hospice-eligible beneficiaries have one of these diagnoses, according to the most recent Medicare hospice data.”

As part of our federal policy agenda, Compassion & Choices has consistently advocated for this type of innovative project as part of our federal policy agenda to reform the end-of-life health care system to make it more patient-centered.

Click here to read the full piece.