By rewarding innovation that lowers expenditures, the ACO model encourages attention to care that exhibits high variation and expense. Both hospice and palliative care have been shown to reduce costs and improve the patient experience, making them potentially powerful tools in an ACO's arsenal. However, the MSSP ACO model has not emphasized care of seriously and terminally ill individuals, and thus it is not surprising that there has been consistently low inclusion of hospice and palliative care physicians in MSSP provider networks.
Results. We received data from 49 (49%) medical directors and 39 (44%) hospice administrators. We observed variation in access to some therapies, such as palliative chemotherapy (29% did not cover), blood products (50%), hormonal cancer treatment (45%), TPN (37%), and vaccines (60%). Importantly, 20% could not support patients using methadone (20%). The reasons for not offering these treatments included: cost, perceived futility, hospice philosophy, and lack of trained staff. Most hospices (60%) reported recommending temporary disenrollment for patients to access services hospice could not provide. Most hospices lacked the ability to provide charity care (60%) or offer sliding scale payment (52%) to indigent patients. Many hospices lacked services tailored toward racial or ethnic minorities (40%). Conclusion. There is variation in the kinds of services hospices in Michigan can offer. We discovered a significant proportion of hospices limit access to some palliative treatments and medications, and cannot offer support for impoverished patients or ethnic minorities.
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