Curative treatments, and even some palliative treatments that are prohibitively expensive, are not an option once a patient enrolls in hospice. That has been a pretty solid line in the sand since the foundation of the Medicare Hospice Benefit. It has created a demarcation between “curative” and “palliative” care that is based more on a payment model than what is best for the patient. Recently, that line has been blurred in some cases, and we are finding that the benefit of concurrent care – allowing curative treatments to be given (and paid for by insurance) while a patient is on hospice – can actually bring benefits not only to the patient, but to the payer as well.
When concurrent care is allowed, the patient benefits. It “smooths practical, psychological, and physical care transitions”, according to a recent JAMA Health Forum Special Communication. This provides quality of life gains for both the patient and their caregivers, easing their end-of-life journey. Concurrent care also benefits payers in reducing unnecessary spending and acute utilization, transitioning patients from curative treatments in a timelier manner, and initiating a patient-driven, holistic plan of care sooner. For hospice providers, concurrent care allows for longer lengths of stay and admission of patients who would otherwise forgo hospice entirely, which empowers staff to do the transformative work that they can do. Concurrent care is currently allowed through Medicaid’s pediatric hospice coverage and the Veteran Administration’s hospice benefit. Within Medicare, some Medicare Advantage VBID contracts, some ACO contracts, and the Kidney Care Choices Model all allow for some form of concurrent care. Whether it be through a modification of the hospice benefit or sustainable reimbursement for non-hospice palliative care programs, hopefully concurrent care coverage will continue to expand. Hospices themselves may be culturally challenged to blur the line between treatment and hospice, but if providing the best end-of-life care is the mission of hospice, it needs to happen.
“Concurrent Care is a Win-Win for Patients, Payers, Researchers Say” by Adam Healy, posted by McKnights Home Care on August 29, 2023, and accessible at https://www.mcknightshomecare.com/concurrent-care-offers-benefits-to-patients-payers-researchers-say/
“Concurrent Care as the Next Frontier in End-of-Life Care” by Natalie C. Ernecoff and Rebecca Anhange Price, posted by JAMA Network on August 18, 2023, and accessible at https://jamanetwork.com/journals/jama-health-forum/fullarticle/2808464?resultClick=1