Medicare Aims To Help Patients In Hospice

HOST INTRO: Every year, a million Americans elect to spend the final days of their lives in hospice. Going into Hospice care is an acknowledgement that a disease is terminal, that further treatment would be futile and that a person is going to die. Now, Medicare is experimenting with a program that aims to improve quality of life for terminally ill patients and save money. Kate Cox reports.

COX: Death is a process. Jonathan Keyserling is a health policy expert at the National Hospice and Palliative Care Organization.

KEYSERLING: “End of life experiences are deeply emotional and fraught with psychological implications.” (00:07)   

One of the most agonizing dilemmas patients and their families face is whether to continue care intended to cure their illness. Under the current Medicare regulation, a patient has to suspend such treatment in order to access the hospice benefit.

Some patients thrive in hospice and sometimes even live longer. Jodi Fitzpatrick’s father was one of those patients. He received hospice care in a nursing home.

FITZPATRICK: “It sustained him so much, he lived past six months.” (00:03)

She says it was the one-on-one interaction with his caregivers that improved his quality of life.

FITZPATRICK: “You know for my dad, it was really that social interaction. So it stimulated him, like having somebody go in and see him, having the nurse go in, having the case manager go in. Having somebody go in and just push his wheelchair around.”  (00:12)

Patients can also be treated in their own homes or in-patient facilities.

But the average hospice stay is short, just two weeks before death comes. that’s because patients often put off going into hospice because they–and their families– don’t want to give up on receiving treatment for their disease.

Care Choices is a new pilot program that is part of the Affordable Care Act. It allows the continuation of some treatments called “curative” even in Hospice. Keyserling says Medicare wants to know if patients would enter hospice care earlier if they could continue some  treatments, such as some kinds of Chemotherapy. . It would be a win win.

KEYSERLING: “Uh, let’s follow the math.” (00:03)

In a hospital that intervention can cost as much as $1000 a day. Daily hospice care averages under $500 in comparison. Jonathan Keyserling says under this program, care will be cheaper and better.

KEYSERLING: “If we could reduce by one or two days the utilization of those high-cost conventional interventions, we may get less stress on the patient and hopefully they can net savings.” (00:15)

But how does Medicare decide what treatments can and can’t continue? Terry Berthelot is a patient advocate at the Center for Medicare Advocacy and a former hospice provider. She says the word “curative” is problematic.

BERTHELOT: “So when we use the word, “curative,” we mean “cure.” Like, I’m not gonna have cancer anymore. I’m going to be living for a long time and this is going to be changed into a chronic illness.” (00:10)

Berthelot is concerned that patients and families understand what a realistic treatment looks like under the new program. She says a condition like chronic obstructive pulmonary disease can be managed but not cured.

BERTHELOT: “You know, there’s no chemo for chronic obstructive pulmonary disease. There are many medications to control the symptoms but there’s no cure for it.”

So “curative” does not necessarily mean “cure.” For the diseases included in the pilot program — advanced cancers, congestive heart failure, HIV and chronic obstructive pulmonary disease — there is no cure.

But certain treatments can make people feel better and keep them out of hospitals.  That was true for Jodi Fitzpatrick’s father, who died from kidney failure. She says she learned from him that quality of life means comfort and time to acknowledge death in your own way.

FITZPATRICK: “Your parents bring you into this world and then your parents teach you how to live. If you’re very, very lucky, they teach you how to die.”(00:10)

Medicare expects to enroll 30,000 beneficiaries in the Care Choices program over a three-year period, beginning this summer.

We don’t yet know how combining hospice care and curative treatments will change the end of life process. But for some, not having to choose between the two may be change enough.

Kate Cox, Columbia Radio News.

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