NHPCO Stresses Position on Hospice Carve-in Proposal
For Immediate Release:
April 22, 2014
NHPCO Repeats Objections to MedPAC Recommendation to “Carve-in” Hospice
Recent essay published in JAMA continues dialog on MedPAC recommendation
(Alexandria, Va) – In a Viewpoint essay that was published in the April 13, 2014 edition of JAMA, “Integrating Care at the End of Life: Should Medicare Advantage Include Hospice?” authors David G. Stevenson, PhD, and Haiden A. Huskamp, PhD, explore MedPAC’s recent recommendation of ending the hospice carve-out for Medicare Advantage beneficiaries. While potential advantages and negative tradeoffs are discussed in this Viewpoint piece, the National Hospice and Palliative Care Organization emphasizes its position that the MedPAC recommendation would provide less hospice choice for Medicare Advantage beneficiaries, and at a higher cost.
In their discussion, Drs. Stevenson and Huskamp point out several of the potential problems with making hospice a carve-in under Medicare Advantage plans, issues such as: Questions of accountability for end-of-life care quality; lack of current quality measures that would be needed; influence of broader financial incentives from Advantage plan managers; limited choice for beneficiaries; and challenges presented to hospice providers who may be forced into negotiating lower reimbursement rates.
Another significant issue would be the increased cost to Medicare. According to a study by Avalere Health (PDF), commissioned by NHPCO, the MedPAC proposed “carve-in” of hospice would cost Medicare an alarming $1.3 billion over a ten-year budget window.
These are issues that NHPCO has voiced in its official statement regarding the flawed MedPAC recommendation released March 14, 2014.
As Drs. Stevenson and Huskamp write in the JAMA essay, “Hospice and palliative care services have been associated with higher quality of life, higher patient and family satisfaction, longer survival, and, for some populations, lower Medicare expenditures.” NHPCO warns against changing a benefit that is already working effectively.
“Any change in the Medicare hospice benefit that would jeopardize availability of high-quality end-of-life care is not worth the gamble,” said J. Donald Schumacher, NHPCO president and CEO. “Dying Americans and their families – cared for by hospice providers in the U.S. – deserve the best that humankind can offer – without tradeoffs that would negatively affect hospice care.”
Helpful information from NHPCO and the Hospice Action Network:
- NHPCO statement, “MedPAC Recommends Less Hospice Choice for Medicare Advantage Beneficiaries, At a Higher Cost” (03/14/14)
- Issue Briefing: Hospice and the Medicare Advantage “Carve-In” (03/2014)
- Advocate Backgrounder on hospice and Medicare Advantage
- NHPCO letter to MedPAC on Medicare Advantage “carve-in” proposal (12/2013)
- How much will MedPAC’s proposal cost Medicare? NHPCO asked Avalere Health to find out (03/2014)
Senior Vice President, Communications