Achieve Savings and Increase Patient Satisfaction by Utilizing Hospice at the Right Time

Medicare has seen significant changes over the last 50 years. Medicare spending in 1970 was 7.5 billion and has increased to 926 billion dollars in 2020. Medicare spending is forecasted to continue to grow to a staggering 1.78 trillion dollars by 2031 as the population continues to age. About 25% of all Medicare spending goes towards care for people during their last year of life. New treatments for cancer, prolonged life for Alzheimer's patients, healthcare breakthroughs, and regional admissions variances in the acute setting are just some of the contributing factors. 

Medicare has turned to various programs to curb the spending growth. Managed care has seen significant enrollee increases over the last decade. 

• Medicare Advantage programs had 23.9% of all Medicare enrollees in 2009 and have over 41% in 2021 (a 58% increase in 12 years).  
• Other CMMI demonstration programs such as Direct Contracting Entities (DCE’s), Institutional Special Needs Programs (ISNP) and Programs of All-Inclusive Care for the Elderly (PACE) have shifted traditional Medicare coverage to a managed approach. 
• Several companies are focused on the high-risk patient populations (about 5% of the Medicare eligible population) who spend as much as 50% of every Medicare healthcare dollar.   

Managed care organizations are providing focused care at the right time with the right treatments. Case managers follow the patients care through the acute setting utilizing hospitalists (employed or contracted) who then transfer their patient to the appropriate level of care. Within the scope of curative care, case management is a vital component of the process. 

Despite those high and escalating health care costs, numerous studies demonstrate that seriously ill patients and their families receive suboptimal care, characterized by untreated pain and other physical symptoms, spiritual and emotional distress, high family caregiving burdens, and unnecessary or unwanted treatments inconsistent with their previously stated wishes and goals for care. Even with this managed approach, end-of-life discussions are not addressed. Many times, patients end up in emergency rooms without a DNR and a host of potentially unnecessary treatments are administered.   

Hospice’s plan of care can be a strong match with managed care organizations. Many high-risk patients’ could be assessed for hospice or a community based palliative care or serious illness program. Palliative care provides a bridge to the patients’ next plan of care. Studies have consistently demonstrated that hospice is associated with reductions in symptom distress, improved outcomes for caregivers, and high patient and family satisfaction.  Recent evidence also indicates that continuous hospice use reduces the use of hospital-based services—including emergency department visits and intensive care unit stays—and the likelihood of death in the hospital.

The Medicare Hospice Benefit also covers drugs for pain and other symptoms and inpatient respite care to ease the caregiving responsibilities of the family.  If a patient is in a managed care organization (MCO), they can select any hospice. 

Hospice reduces the family burden on many levels with an interdisciplinary team approach. Bereavement services are available to the family for at least a year after the death, so hospice patients can be reassured that support will continue well after they are gone. Hospice is the right care at the right time for patients who are eligible, while working to support the goals of managed care.