The Future of Hospice: Concurrent Curative Care?

[KMRN81]

Hello fellow hospice nurses,

I'd like your opinion on the upcoming changes being implemented by CMS. Particularly, the "Medicare Care Choices Model", which will allow certain Medicare beneficiaries to pursue both hospice and curative care. Here is the link to the CMS description (it's the 4th bullet point down): http://www.cms.gov/Center/Provider-Type/Hospice-Center.html

Here is some additional information about the potentially blurred line between curative care and hospice care: http://www.medicareadvocacy.org/medicare-care-choices-model-is-it-better-for-hospice/

What are your thoughts on this change? How do you feel it will affect hospice care, and the kind of care we provide our patients? Can you see the potential benefits, or pitfalls, of this new model of care? Can you think of other options (i.e. better implementation of palliative care by hospitalists)?

I have my concerns (outlined in the Medicare Advocacy link that I linked to above; scroll to section 2A and 2B), but would love to hear others' ideas and opinions about it.

[TammyG]

Just wanted to note that it is a Medicare demonstration project, not an upcoming change. Hospices submitted proposals last month to participate in the project. If selected, they will begin with limited participation in 2015.

[toomuchbaloney]

It is common for folks to participate in aggressive palliative care while also pursuing cure of the ailment that will likely end their lives, if there is a palliative program in their area.

[NC29mom, ASN, LPN, RN]

just my two cents.....I have noticed patients who refuse chemo and radiation live longer. much longer....I've had some last 1-2 years, while another pt with comparable metastasis who chose to undergo chemo/radiation only lasted a days to weeks. I know there are several other factors to consider. ....just noticed a trend.

I sometimes wonder just how honest oncologists are with their pts when talking about chemo/radiation and how much time & quality of life mt really buys.

yes, I heard about this pilot program incorporating palliative/ curative care. it was about the same time Medicare had released the new Part D rules for RELATED meds.....wow...from one extreme to another

[lifelearningrn, BSN, RN]

My "knee jerk" reaction was to criticize this, it seems to be counter-intuitive to hospice. HOWEVER, after reading the purpose of the program, I don't necessarily disagree, as some people aren't quite ready to give up 'hope' or the comfort of 'healing' medications. Many of those patients would greatly benefit from the interdisciplinary approach to hospice and all the benefits hospice has to offer. This isn't necessarily a bad thing.

[toomuchbaloney]

Almost all pediatric hospice care is provided while aggressive treatment continues, in my experience.