NURS 501 Week 7 Health Policy Issue Position, a Narrated Briefing for Decision Makers Example

Comfort Without Giving Up: A Briefing on Transitional Concurrent Care in the Medicare Hospice Benefit

Slide 1: The Request

• Create a transitional concurrent care benefit in Medicare hospice
• Up to 90 days of hospice support while treatment continues
• Evaluated, targeted and reviewed after three years

Speaker notes: I appreciate the chance to brief your health staff this morning. I am a registered nurse and MSN student, and I am asking your office to support legislation creating a transitional concurrent care benefit in the Medicare hospice program. Under this proposal, a beneficiary who is terminally ill could receive hospice nursing, symptom management and family support for up to 90 days without first giving up treatment for the illness. The benefit would be evaluated against a matched comparison group, focused on patients with frequent hospital use, and reviewed by Congress after three years. In the next twelve minutes I will cover why the change is needed, what Medicare's own test of it showed, and how the costs and risks can be contained.

Slide 2: One Patient's Choice

• Metastatic cancer, still on chemotherapy
• Offered hospice, told to stop treatment first
• Two admissions, then hospice four days before death

Speaker notes: Let me start with a composite patient. Picture a retired schoolteacher whose pancreatic cancer has spread; chemotherapy continues, but pain and fatigue now fill most days. The oncologist suggests hospice, and the patient wants the help, but Medicare requires giving up treatment for the cancer to get it. So the chemotherapy continues, two hospital stays follow, and hospice finally begins with only four days left. Nurses see this pattern every week. The question for policymakers is whether the program's rules are causing part of it.

Slide 3: Hospice Arrives Late

• 1.8 million beneficiaries used hospice in 2024
• Median stay: 19 days
• One in four stayed 5 days or fewer (Medicare Payment Advisory Commission, 2026)

Speaker notes: Hospice is widely used. The Medicare Payment Advisory Commission's March 2026 report counts over 1.8 million hospice users in 2024, close to 53 percent of all Medicare decedents. Yet the typical stay was short: the median was 19 days, and one patient in four was enrolled for 5 days or less. Hospice teams can relieve pain in hours, but helping a family prepare, managing medications at home and preventing crisis admissions take weeks. For many patients, the benefit comes after the time when it could do the most good.

Slide 4: What the Current Rule Requires

• Election waives Medicare coverage of other care for the terminal illness
• Treatment such as chemotherapy or dialysis is usually stopped
• Hospices paid a daily rate, so costly treatment strains enrollment

Speaker notes: The barrier is built into the election. Signing the election statement means accepting comfort-focused care from the hospice for the terminal illness and waiving Medicare payment for other care aimed at that illness, a condition written into the federal regulation on hospice election (Election of Hospice Care, 2025). Medicare still pays for unrelated care. Hospices also receive one flat payment per day, so a patient whose palliative treatment is costly can lose the hospice money, and some hospices respond by declining such patients. The result is a choice between comfort and treatment that many patients postpone.

Slide 5: Medicare Already Tested Concurrent Care

• Care Choices Model, 2016 to 2021
• Hospice support plus ongoing treatment for four diagnoses
• Net Medicare spending down 13% (Kranker et al., 2023)

Speaker notes: Medicare has already tested the alternative. Between 2016 and 2021, the Medicare Care Choices Model offered hospice-style support to people with four serious diagnoses, including advanced cancer and heart failure, without asking them to stop treating the disease. The independent evaluation, published in Health Affairs in 2023, compared enrollees with matched beneficiaries who received usual care. Compared with similar beneficiaries, participants received aggressive life-prolonging care in the final weeks 15 points less often, gained over five days at home, and used hospice 18 points more often. Net Medicare spending fell by 13 percent.

Slide 6: Fewer Crises, More Days at Home

• Inpatient admissions down 26%
• Outpatient emergency visits down 12%
• Gains in every underserved subgroup studied (Niedzwiecki et al., 2024)

Speaker notes: The savings came from avoided crises. Inpatient admissions fell by 26 percent and outpatient emergency visits by 12 percent. A follow-up analysis in Health Services Research looked at rural enrollees, people covered by both Medicare and Medicaid, and minority beneficiaries, and found the same improvements in each of those groups, with some gaps narrowing. One caution: those groups were underrepresented among enrollees, so any new benefit must be designed to reach them.

Slide 7: Why It Worked

• Early and frequent home assessments
• 24-hour nurse telephone access
• Coordination with the treating specialist (Rowan et al., 2024)

Speaker notes: How did the model work? Researchers reviewed more than 217,000 encounters with over 7,000 enrollees and interviewed staff at high-performing hospices. Five things made the difference, according to that review: assessing needs early and often, seeing patients in person at home, answering new problems right away, giving families a nurse to call at any hour, and keeping the patient's doctors informed. Most of these are nursing services. That matters for policy design, because a new benefit should require them rather than assume them.

Slide 8: Four Options

• Keep the current rule
• Revive a voluntary CMS model
• Legislate transitional concurrent care
• Raise hospice payment for high-cost patients

Speaker notes: We considered four options. Keeping the current rule costs nothing new but preserves late enrollment and crisis admissions. Reviving a voluntary model could be done by the Innovation Center without legislation and would generate more evidence, but the earlier model reached fewer patients than planned. Raising payment for high-cost patients would help those turned away by hospices, but not those who decline hospice because they must stop treatment. Legislating a transitional concurrent care benefit is the only option that reaches every eligible beneficiary. Children already have concurrent care in Medicaid, and a pediatric cost study found it reduced live discharges from hospice, though at higher cost in some age groups (Svynarenko et al., 2024).

Slide 9: The Recommendation

• Up to 90 days of concurrent care after hospice election
• Required services: home assessment, 24-hour nurse access, care coordination
• Start with the four tested diagnoses, then expand

Speaker notes: We recommend legislation that lets a beneficiary elect hospice and continue treatment for up to 90 days. Hospices would be paid the usual daily rate, treatment would be billed as it is now, and hospices would be required to provide the services linked to the model's results. The benefit would begin with the four diagnoses already tested and expand after the first evaluation. This design keeps the benefit close to the population in which savings were shown, while giving every eligible beneficiary access rather than only those near a participating hospice.

Slide 10: Safeguards and Next Steps

• Matched evaluation reported to Congress
• Equity reporting and outreach requirements
• Payment review after three years

Speaker notes: We understand the concerns about cost and program integrity, and the proposal answers them directly. An independent evaluation would compare enrollees with similar patients, hospices would publish who they enroll and reach out where groups are missing, and Congress would revisit the payment terms in year three. Our request is that your office support drafting this legislation and request a Congressional Budget Office estimate based on the model's results. Nurses, hospices and families are ready to help. I can send the full written analysis to your staff today, and I welcome any questions.

Slide 11: References

• Election of Hospice Care (2025), the federal election regulation.
• Kranker et al. (2023), Health Affairs.
• Medicare Payment Advisory Commission (2026).
• Niedzwiecki et al. (2024), Health Services Research.
• Rowan et al. (2024), American Journal of Hospice and Palliative Medicine.
• Svynarenko et al. (2024), Journal of Hospice and Palliative Nursing.

References

Election of Hospice Care, 42 C.F.R. § 418.24 (2025). https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-418/subpart-B/section-418.24

Kranker, K., Niedzwiecki, M. J., Pohl, R. V., Saffer, T. L., Chen, A., Gellar, J., Forrow, L. V., & Miescier, L. (2023). Medicare Care Choices Model improved end-of-life care, lowered Medicare expenditures, and increased hospice use. Health Affairs, 42(11), 1488-1497. https://doi.org/10.1377/hlthaff.2023.00465

Medicare Payment Advisory Commission. (2026). Hospice services. In Report to the Congress: Medicare payment policy (pp. 293-324). https://www.medpac.gov/wp-content/uploads/2026/03/Mar26_Ch10_MedPAC_Report_To_Congress_SEC.pdf

Niedzwiecki, M. J., Forrow, L. V., Gellar, J., Pohl, R. V., Chen, A., Miescier, L., & Kranker, K. (2024). The Medicare Care Choices Model was associated with reductions in disparities in the use of hospice care for Medicare beneficiaries with terminal illness. Health Services Research, 59(4), Article e14289. https://doi.org/10.1111/1475-6773.14289

Rowan, P., Whicher, D., Luhr, M., Miescier, L., Kranker, K., & Gilman, B. (2024). Supportive services at end of life can help reduce acute care services: Observations from the Medicare Care Choices Model. American Journal of Hospice and Palliative Medicine, 41(9), 1037-1044. https://doi.org/10.1177/10499091231216887

Svynarenko, R., Cozad, M. J., & Lindley, L. C. (2024). An age group comparison of concurrent hospice care: A cost-effectiveness analysis. Journal of Hospice and Palliative Nursing, 26(4), 219-223. https://doi.org/10.1097/NJH.0000000000001037