Families Attack Medicare Hospice Provider Quality

News February 02, 2023 at 01:34 PM
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Patients are complaining that some hospice programs shortchange dying Medicare enrollees and their families.

In response, Medicare program managers are promising that a new, improved hospice program quality rating program is going through a national testing process.

The Centers for Medicare and Medicaid Services, the agency that oversees Medicare, posted an update on the Hospice Outcomes and Patient project, or HOPE project, last week.

"When finalized in future rulemaking, HOPE will be implemented in the Medicare Hospice Benefit to provide value to hospice providers, patients and families," CMS officials said.

What It Means

Any new hospice quality rating tool could help you give better advice to some of your most vulnerable clients: People who have a life expectancy of less than six months and their families.

Advisors who are taking hospice program problems into account might want to encourage clients to consider increasing the pot of savings earmarked for health care expenses and buying recovery care insurance, or short-term care insurance.

Some advisors might want to vet and form referral relationships with elder care management and advocacy services.

The Medicare Hospice Program

Medicare is a federal program that covers health care for 65 million Americans who are over the age of 65, qualify for Social Security disability insurance or have the kind of kidney disease that leads to dialysis and organ transplants.

For people who appear to be nearing the end of life and who agree to go without the kind of care that might be provided in an effort to cure their conditions, hospice programs provide extra coverage for care that might make the patient feel more comfortable.

The extra benefits could cover home health care services, medical supplies and some services resembling long-term care services, such as homemaker services and short periods of inpatient care intended to give a family caregiver a break.

Normally, Medicare declines to pay for homemaker services and other long-term care services. Patients who need those services must pay out of their own pockets, use private insurance to pay the bills or exhaust their assets and qualify for Medicaid nursing home benefits.

The Hospice Care Controversy

Patients have been talking about concerns about hospice care quality for years.

The concerns took center stage in November 2022, when The New Yorker ran a widely read article by Ava Kofman about hospice care providers that appear to cut spending by skimping on services for patients who are living in their own homes.

Hospice Quality Data

Medicare collects some information about the services hospice providers have delivered, based on reviews of patient admissions and discharge data, but that effort does not provide information about how well programs met patients' needs, officials noted.

CMS wants the HOPE program to gather information about how fair the programs are to different kinds of patients and how well the programs perform on standardized quality measures, such as measures for how comfortable patients are and how quickly they get care.

An Agent Trainer's Perspective

Ari Parker, the head advisor trainer at Chapter, a Medicare plan broker, said the firm has about 45 coverage advisors. He hears from advisors about the calls they get several times per month from clients having problems with hospice benefits.

Hospice "is one of the most difficult subjects you can discuss with someone," Parker said.

Helping clients understand and use hospice benefits "is part of our responsibility," he said. "It's very much core to our mission."

Chapter can offer some extra support, he said, because it has a homegrown system that can list every hospice provider in the United States by ZIP code, and advisors can give callers contact information for nearby hospice providers.

Parker would like to see CMS add hospice information, including quality rating information, to the Medicare.gov website Plan Finder tool.

Parker sees the lack of hospice information on the Plan Finder site as one of the many weaknesses of the site.

Like many agents and brokers in the Medicare plan market, Chapter executives have been frustrated with the state of the Plan Finder tool since it was updated in 2019, shortly before the COVID-19 pandemic came to light.

Chapter's CEO co-wrote an article, published in November 2022, contending that the Plan Finder tool still lacks the feature consumers need to determine whether their providers are in a plan's network, compare plans based on prescription drug coverage and comparing plan supplemental benefits, such as dental, vision and hearing benefits.

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