Evaluating Policy Solutions Aimed at Improving Hospice Care Access in Rural Areas

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PROJECT SUMMARY/ABSTRACT Project 4 (Gilstrap): Evaluating Policy Solutions Aimed at Improving Hospice Care Access in Rural Areas In 2016, almost 1.5 million Medicare beneficiaries enrolled in hospice and an equal number, if not more, were eligible but chose not to enroll. Hospice can provide a myriad of benefits for patients and caregivers, and has been shown to decrease futile care at the end of life, making under-enrollment a problem. With only 34% of rural decedents enrolled in hospice as compared to the 51% in urban areas, rural under-enrollment contributes to a higher rate of acute care at end of life. In 2016, the Center for Medicare and Medicaid Services (CMS) launched the Medicare Care Choices Model (MCCM). This voluntary program aimed to address the “acceptability,” aspect of hospice access, by allowing patients to enroll in hospice without stopping treatment for their terminal condition. Though early results suggest that the program increased enrollment and decreased spending, it remains unclear how the MCCM program performed in rural areas, what factors predicted success in rural areas, and whether increased demand for services was met by rural hospice agencies. This project will investigate these gaps in knowledge using relevant, timely, and innovative analyses and methods. As the research team works to examine the impact of MCCM in rural areas, determine the residual barriers to hospice expansion in rural areas, and model the estimated impacts of various policy solutions, they will leverage large data sets, novel crosswalks, qualitative interviews, and simulation modeling. The work on this project will ultimately prepare the PI, Dr. Gilstrap, to develop and submit an R01 application with the aim of implementing and testing strategies identified in this grant to quantify their impact on rural hospice enrollment.