VNA’s Medicare Care Choices Model to Expand Throughout State of NJ

In January 2016, VNAHG Hospice began participating in a project through the Centers for Medicare Innovation called the Medicare Care Choices Model (MCCM). This hospice model of care provides supportive services, focusing on patient and family support from the hospice interdisciplinary group as well as help with goals of care conversations and navigation through care by the hospice nurse. Patients are allowed to receive concurrent aggressive and curative treatment while enrolled in this model of care. VNA of Englewood, VNAHG’s Joint Venture with Englewood Hospital and Medical Center, was the first hospice in Bergen County, New Jersey, to roll out the program. 

As a selected participant in MCCM, VNA of Englewood Hospice tested being embedded at the site of health care and other new approaches to hospice care. They are among a select group of 140 + hospices across the nation that are participating in the program: 70 hospices rolled out the program in January 2016 with the other half of the hospices rolling out in January 2018.

The VNAHG Hospice Program will be part of the 2018 roll out as it introduces the model to its RWJBarnabas Joint Venture Hospice programs in Essex, Passaic, Morris, Hudson, Union, Somerset, Middlesex and Monmouth counties. This model of care will embed hospice workers in the cardiac, pulmonary, and oncology clinics in the RWJBarnabas system.

The Englewood Branch tested embedding a Nurse Case Manager for MCCM in the Englewood Hospital and Medical Center’s (EHMC’s) HOPE Oncology Center in June of 2016. Physicians, patients and families have had positive results with the integration of care. “When patients present with an advanced disease, getting that hand-holding team with palliative care up front gives them longevity and better quality of life, and it allows me to give them the best treatment options,” said Minaxi Jhawer, MD, Chief of Hemotology/Oncology, Englewood Hospital. “As a whole, it’s a fantastic team approach.”

“The embedding practice implemented by VNA of Englewood Hospice has had very positive results, with more people having access to the support and benefits of the hospice inter-disciplinary team earlier on in the trajectory of their life limiting illnesses,” said Keri Linardi, RN, BSN, PHN, CHPCA, Vice President of Hospice at VNAHG. This practice was identified as a best practice; The VNA of Englewood presented details about their observations at the DHHS Training Program for MCCM participants across the country on October 5 and 6, 2017 in Baltimore, Maryland. 

The VNA of Englewood Hospice also found that the embedding practice was very beneficial to patients, their families, and other caregivers. Under current Medicare rules, patients must forgo curative care to receive services under the Medicare or Medicaid Hospice Benefit, but this trial model allowed hospice staff to begin hospice care while continuing aggressive or potentially curative care. The VNA hospice staff were on site once weekly or more in the oncology offices at HOPE Oncology Clinic of EHMC.

“With us embedded at the hospital, the oncologists really embraced our program,” said Noreen Rathgeber, RN, CHPN and MCCM Program Director. “In this model, patients with cancer, cardiac, pulmonary and HIV have the option to continue treatment for their life-limiting illness, and can also receive hospice support services. For the oncologists, it was comforting to know that they didn’t have to give up treatment for their patients.”

The data CMS collects from the hospice programs will be used to determine whether or not trial best practices can improve patient outcomes. Expected outcomes include increasing access to supportive care services provided by hospice: currently, fewer than half of eligible Medicare beneficiaries use hospice care and most only for a short period of time. Other outcomes may include improving the quality of life and care received by Medicare beneficiaries, increasing patient satisfaction, and reducing Medicare expenditures.

Members of the public who have questions, referrals or concerns about the program should email mccm@vnahg.org or call the VNAHG Hospice at 800-200-2345.

A VNA patient’s daughter shares the experience her mother had while on the MCCM Program in the video below: