Aetna: Change Medicare hospice rules to improve care, cut costs

May 22, 2014 | By Alicia Caramenico

Palliative and hospice care improvements can lead to an increase in satisfaction and care quality for Medicare Advantage beneficiaries with advanced illness and a drop in unnecessary services, according to Aetna, LifeHealthPro reported.

Aetna National Medical Director for Medicare Randall Krakauer, M.D., urged Congress to improve end-of-life benefits for Medicare Advantage members by making hospice rules more flexible. "[C]urrent Medicare rules serve as a barrier to providing optimal care to beneficiaries with advanced illness," he said yesterday at a hearing for the Senate Special Committee on Aging.

For example, beneficiaries must forego curative treatment before they can enter hospice, noted Krakauer. Medicare should let patients get hospice care while continuing treatment of their illness, thereby allowing health plans to implement more case management.

Aetna's case management program has brought down costs, primarily through reduced hospitalizations and emergency room use. In fact, Aetna's case managers can save from $2 to more than $9 per member per month, FierceHealthPayer previously reported.

Krakauer also recommended extending hospice eligibility from a six-month terminal diagnosis to 12 months. He also voiced support for including end-of-life care measures into the star quality rating system.

"We believe that measuring health plans' progress in caring for members with advanced illness helps ensure that individuals and their families receive the compassion and support that is critically important at the end of life," Krakauer said, according to a written version of his testimony.

Aetna already applies such rules to certain commercial members. It also provides an unlimited number of hospice inpatient days, eliminates outpatient hospice dollar limits and gives family members 15 days of respite care and bereavement services. Thanks to these end-of-life policies, commercial members had higher hospice election rates, improved satisfaction and lower acute utilization, Krakauer said.

In addition to Medicare Advantage plans, insurers may want to focus on palliative care for members participating in their accountable care organizations for high-quality, low-cost care.

For more:
- read the LifeHealthPro article
- check out the hearing