A fledgling hospice program has local administrators excited about what could be a major shift in how people think about the service.
Last January, Mountain View Hospice & Palliative Care first implemented Care Choices, a “demonstration project” or study run by Medicare to increase patient participation in hospice and get them involved at an earlier stage.
It allows those still working toward curing a terminal illness to utilize hospice services.
“Traditional hospice doesn’t allow you to do curative treatment,” said Sheila Jones, director of marketing and public relations for the local facility, which operates eight locations in North Carolina and Virginia including Mount Airy, Dobson and Pilot Mountain.
In the traditional sense, a family turns to hospice when a loved one has a terminal illness. The patient’s symptoms and pain level are managed as best as possible until the patient dies.
“They can still get treatment for palliative reasons or comfort care,” she explained, “maybe shrinking a tumor to be more comfortable, but not trying to shrink the tumor to get rid of it is an example of that.”
Through Care Choices, patients who meet certain criteria can participate in hospice even if they are receiving curative treatment.
The study was first implemented at Mountain View’s North Carolina locations a year ago.
The agency is one of about 140 out of about 6,000 in the United States to be accepted into the program, Jones explained.
“Not all hospices got to participate, and not all hospices wanted to participate,” Jones said.
Hospice agencies had to apply and be accepted in the study.
Once accepted, Mountain View sent representatives to Medicare headquarters in Maryland for training.
“We operate on that we’re a community-focused hospice so we want to give back and do our part,” she said of why Mountain View wanted to give it a shot.
“But we also want to be part of the change,” towards holistic care, she said. “This is a way we can be advocates for those patients.”
Medicare initiated the program as a way to decrease overall costs and improve patient care.
“They wanted to see if these patients have these diseases and they can do hospice and curative treatment at the same time, would they do it, would it be beneficial and what would the outcome be,” Jones said.
“People going in and out of hospice in the Medicare program is hugely expensive,” she said. “We’re trying to lower the cost of medical costs and saving that program,” she said of Medicare.
“Hospice is proven to save Medicare money,” she said. “We keep people out of the hospital, we provide services at home, we keep the hospital stays down. It’s that team approach where you’re taking care of the patient as a whole.”
The patients benefit in numerous ways by earlier participation in the program, according to Jones.
“Physician collaboration is one of the big benefits,” she said. A patient suffering from a terminal illness may be receiving care from several different specialists.
“This program helps to get all those folks on the same page,” Jones said. “Hospice is good at that.”
In addition to coordinating medical care with a team of physicians and nurses, hospice also provides emotional and spiritual support with social workers, chaplains and volunteers.
“It’s just a better care approach,” of which those still fighting their disease can take advantage, Jones said.
Another benefit is that when a patient and family are confronted with the desire or necessity to change their level of care from fighting an illness to managing symptoms, hospice is already on board.
“We can help have those conversations,” she said. Those relationships, and the trust with caretakers and providers, have already been built.
An additional benefit has manifested within the local agency itself.
“This program has made us look at our referrals in a whole new, different way,” Jones said, in terms of connecting patients to services they need even if they don’t qualify for traditional hospice or Care Choices.
“Which we did this anyway before,” Jones said, “but this program has made us do it more on paper.”
Unfortunaely, locally and nationally, participation wasn’t what Medicare had hoped to see in the program’s first year.
Jones said the stigma associated with hospice is one barrier for those who are still fighting to live, but then the program’s own stringent criteria for participation kept out some folks who could have benefited.
Jan. 1 brought some changes to that criteria.
• Those enrolled in Medicare Part A or B are now eligible. Formerly, only those enrolled in Medicare Part D could participate.
• Those who have been to the hospital in the last 12 months due to their illness and have seen their doctor three or more times for any reason are eligible. This is expanded from those who have seen a doctor three or more times specifically for their illness.
• Last year, participants were required to have a prescription drug plan. This year they do not, although hospice will help participants find an appropriate plan.
Other criteria remained the same: patients must be currently living at home and have a terminal diagnosis for cancer, COPD, heart failure or HIV/AIDS.
The local hospice receives a significantly lower reimbursement for Medicare than for traditional hospice; about $400 per month per patient as opposed to about $140 per day, but it’s worth it.
“We love being that community choice and that’s what it’s all about,” Jones said. “It’s about being able to choose how they want to live with whatever disease they have.”
Reach Terri Flagg at 415-4734.