Home Health & Hospice Week

Do good results matter when not enough patients sign up?

The Medicare Care Choices Model received multiple positive results, but it served so few people that it might not matter much.

The pros: MCCM saves Medicare money. “Among enrollees who died before the model ended, net expenditures (Medicare Part A and B expenditures plus MCCM payments) decreased by $7,604 per MCCM enrollee (13 percent) between enrollment and death, on average, relative to a matched comparison group,” the Centers for Medicare & Medicaid Services reveals in a fifth and final evaluation report of the six-year program. Inpatient admissions decreased by 26 percent and outpatient emergency department visits and observation stays decreased by 12 percent.

And deceased MCCM enrollees were more likely to use the Medicare hospice benefit before death than matched comparison beneficiaries (83 percent versus 65 percent); spent more than twice as many days in hospice (42 versus 19 days); entered hospice earlier; had improved quality of end-of-life care; were less likely to receive an aggressive life-prolonging treatment in the last 30 days of life (61 percent versus 76 percent); and spent more days at home before death (183 versus 178 days).

The cons: It was hard for hospices to find eligible beneficiaries to enroll and to serve them on the MCCM budget. “CMS accepted 141 Medicare-certified hospices to participate in MCCM,” but “only 89 hospices (63 percent) enrolled a beneficiary and only 44 (31 percent) participated for all six years.”

In fact, “just 5 hospices enrolled 46 percent of all MCCM enrollees, which limits generalizability,” CMS acknowledges.

Still, “MCCM is a promising approach to increasing hospice use,” CMS concludes in the report summary at www.cms.gov/priorities/innovation/data-and-reports/2023/ mccm-fg-fifthannrpt.