8 AUGUST 2024IN MY OPINIONIN MY OPINIONIN MY OPINIONIN MY OPINIONIN MY OPINIONIN MY OPINIONHospice Is Where Value-Based Medicine Begins and EndsBy Ziad Farah, MD MBA, Chief Medical Officer, Center Light Health PACE and Adjunct Assistant Professor of Medicine, Albert Einstein UniversityHospice, as we understand it in the U.S. healthcare system, is a Medicare benefits package. Patients, who have Medicare Part A, qualify for the benefits if they have a life-limiting illness, have waived further curative care for it, and have two doctors certifying that their life expectancy is six months or less. This certification typically follows established guidelines based on clinical decline, functional and burden of illness indicators, and disease-specific criteria. All are governed by the local coverage determination (LCD). Hospice care is rooted in value-based medicine. With its focus on improving the quality of life and wrapping services around the patient at home, hospice care can reduce the cost and utilization of resources that are wasteful and misaligned with the patient's goals and values. Typically, it is those downstream expenses in the emergency departments and hospital stays. To that end, hospice is one of the earliest CMS-capitated payment models. It was passed by Congress in 1985 with the premise of giving Americans a dignified death at home. All the risk-bearing organizations: managed care MCOs, accountable care ACOs, or physician practices in capitated payment contracts, must take notes, learn from and find ways to align with hospice services. The hospice interdisciplinary team IDT deploys a whole-person approach to a patient with a multitude of medical, functional, social, psychological, and spiritual needs. They are focused on allowing them to live the best life they can ahead, optimizing and stabilizing their current state. They are accustomed to co-managing and collaborating with the primary care physician and the specialist. The hospice physician allows a space for the PCP to manage and preserve the pre-existing relationship with the patient. They step in and take control when there is an acute change of status or when the matter is within the purview of managing the terminal illness. The hospice care managers are clinicians who practice care coordination on a daily basis with parties across the continuum. The hospice clinicians have truly mastered the PCP wrap-around model, and any risk-bearing entity or managed care startup can learn a lot from the way they have operationalized the model.As the medical community embraced a simultaneous Ziad Farah
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