family members, alzheimer's, caregiving

People with advanced illness deserve comfort and treatment

Feb 11 2015

The Centers for Medicare & Medicaid Services (CMS) is expanding a pilot program that will allow people with Medicare to receive palliative (comfort) care while receiving curative (treatment) care at the same time. Originally planned to include 30 certified hospices over three years, the CMS pilot program now will include more than 140 hospices over five years, beginning January 1, 2016. Based on our own experience over ten years with our Compassionate Care Program, we see the CMS pilot program as a positive first step.

The old view of advanced (or terminal) illness was that a person went into hospice to die comfortably. To facilitate a “good death,” the person received palliative care, which delivers relief from the pain, symptoms and stress of a serious illness. Palliative care does not try to treat an illness. Over the years, more forward thinking doctors and caregivers began to question this approach. They challenged the notion that patients at a certain point of their illness should not also receive treatment for the illness itself.

We agree. People should not have to choose between care to treat their illness and care that provides comfort on a day-to-day basis. Giving people with advanced illness more options for care is the compassionate thing to do.

Our Compassionate Care Program gives access to hospice care earlier and allows people to continue receiving curative care while in hospice. Our nurse case managers receive special training in advanced illness and palliative care issues and frequently help address concerns that may be difficult to share in a face-to-face setting. They are able to develop trusting and meaningful relationships with our members and their families.This approach has yielded significant positive results: over the past 10 years, we have seen satisfaction levels above 90 percent for patients and their caregivers. Considering the circumstances, these are notable results.

Supporting people this way is also good for the health care system. It can help reduce unnecessary costly hospitalizations and emergency room (ER) visits. We typically see a drop of about $12,000 in health care costs for each person in our program. For example, the Aetna Medicare Advantage members in the care management portion of our program have seen:

  • 82 percent reduction in days spent in a hospital receiving acute care
  • 86 percent reduction in days spent in Intensive Care Units
  • 78 percent reduction in ER use

In trying times, when people feel like they are losing everything, programs like these can help people take control over the care they need. The expansion of the CMS pilot program, which CMS says is due to robust interest, is expected to enable as many as 150,000 eligible Medicare beneficiaries with advanced cancers, chronic obstructive pulmonary disease, congestive heart failure, human immunodeficiency virus/ acquired immunodeficiency syndrome who receive services from participating hospices to experience this new option and flexibility. We encourage CMS and others to continue to develop programs that give more options to people with advanced illness.

This article was first posted on May 21, 2014, and updated July 21, 2015