Medicare hospice may limit access to concurrent hospice, dialysis among veterans with ESKD
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Veterans with end-stage kidney disease receiving hospice financed by the Veterans Health Administration were more likely to receive concurrent treatments than those receiving Medicare-financed hospice, according to recently published data.
Further, researchers suggest Medicare hospice policy may significantly limit access to concurrent hospice and dialysis care among this population.
“Because most patients with ESKD are eligible for Medicare at any age, many Veterans Health Administration (VA)-enrolled veterans have the option to receive hospice services under either their VA or Medicare benefits. In the context of the VA’s more liberal approach to hospice eligibility and payment, comparative patterns of concurrent care among veterans with ESKD receiving hospice services under Medicare vs. VA could be informative,” Melissa W. Wachterman, MD, MSc, MPH, from the section of general internal medicine at the Veteran Affairs Boston Health Care System, and colleagues wrote. “This study compared rates of concurrent dialysis and hospice use among a cohort of VA-enrolled veterans receiving maintenance dialysis for ESKD and examined which hospice payers financed dialysis treatments after hospice initiation.”
In a retrospective cross-sectional study, researchers explored the frequency of concurrent hospice and dialysis care among all 70,577 VA enrollees with ESKD in the U.S. Renal Data System registry who began maintenance dialysis and died between 2007 and 2016. Researchers considered if the frequency of treatment varied by hospice payer, including Medicare, VA inpatient hospice or VA-financed community-based hospice.
A total of 18,420 veterans with ESKD received hospice services. However, 89% received hospice under Medicare and 28% kept receiving dialysis after hospice initiation. Researchers identified an increase in the adjusted proportion of veterans receiving concurrent care among those enrolled in VA inpatient hospice or VA community than for those enrolled in Medicare hospice. Further, 87% of all treatments after hospice initiation, regardless of hospice payer, were financed by the VA.
“Our findings among the veteran population highlight the importance of several ongoing Center for Medicare & Medicaid Innovation (CMMI) efforts to explore the feasibility of offering concurrent hospice and dialysis services under the Medicare program. In 2020, CMMI created the Kidney Care Choices Model, a value-based payment model in which dialysis facilities, nephrologists and other Medicare clinicians can partner to create Kidney Contracting Entities (KCEs) to provide care in an accountable care organization framework,” Wachterman and colleagues wrote. They added, “If some KCEs elect to offer concurrent care, the initiative could offer a unique opportunity to examine the quality and cost of concurrent care among Medicare beneficiaries and to understand how its provision shapes the end-of-life experience and care of patients with ESKD and their families.”
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