1. Hospice and Palliative Care ROXANNE ROTH MSN, RN DIRECTOR OF INNOVATION

2. Terminology Palliative Care: “to cloak”, “alleviate symptoms of disease without curing it. Hospice Care: team oriented approach to medical care, pain management, and emotional and spiritual support individualized to the patient’s needs and wishes at end of life. Advanced Illness Management: team oriented approach that combines best medical approaches for disease management combined with supportive care with a caregiver focus. 2

3. Features of the Medicare Hospice Benefit FeaturesDetails Patient EligibilityPrognosis of 6 months or less Certified by 2 physicians Part A Medicare Benefit PeriodsTwo 90 day periods Unlimited 60 day periods Recertification process ReimbursementPer diem based on level of care Covered ServicesIDT, Bereavement, Dietary, PT, OT, ST, Drugs, DME, Supplies, Labs, Diagnostics Levels of CareRoutine home care Continuous home care General Inpatient care Respite inpatient care 3

4. Curative Treatment Palliative Care Hospice Current Practice

5. Disease-Modifying Treatment Hospice Care Bereavement Support Palliative Care Terminal Phase of Illness Death Continuum of Care

6. Medicare Care Choices (MCCM) Advanced cancers, chronic obstructive pulmonary disease, congestive heart failure and HIV/AIDS Must meet Medicare hospice eligibility requirements. Must not have elected the Medicare hospice benefit within the last 30 days prior to participation in MCCM Lives in a traditional home Qualify for Medicare/Medicaid hospice benefit. Is enrolled in Medicare Part A, B and D Cannot be enrolled in a Medicare managed care organization, or participated in a Medicare managed care plan for at least 2 open enrollment years