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Concurrent Care

It’s called the terrible choice.

Medicare patients diagnosed with a life-limiting illness are faced with a difficult decision: either continue treating their disease or enter hospice care and shift focus to relieving pain and improving quality of life.

They can’t have both.

Military veterans with VA Healthcare benefits no longer have to make this terrible choice, thanks to a novel program that may herald the future for all hospice-eligible patients.

Since 2009, veterans have been offered concurrent care—simultaneous curative treatment and hospice—as part of the VA Comprehensive End of Life Care Initiative.

Suncoast Hospice Physician and Hospitalist Lead, Jasmin Jerez-Marte, MD, HMDC, said the program has increased veterans’ use of hospice care at end of life from 55 percent to 71 percent.

“The VA recognized a lot of their patients were still wanting to continue treatment offered by the VA,” Dr. Jerez-Marte said. “These are not treatments specifically addressing pain, anxiety, or wound care related to an illness, which is the traditional hospice approach.”

She goes on, “The VA said, ‘We can continue providing those treatments and see if, by doing so, veterans would be more willing to accept hospice care,’ and there was a win.”

Suncoast Hospice is a member of Empath Health, which operates hospice affiliates serving residents of Hillsborough, Pinellas, Polk, Hardee, Highlands, Marion, Sarasota, Manatee, Charlotte, and DeSoto counties.

Empath Health’s commitment to serving veterans and their families is exemplified by the Empath Honors and Tidewell Honors Veterans programs. Empath Honors is a We Honor Veterans program partner, a joint initiative of the National Hospice and Palliative Care Organization and Veterans Affairs.

Empath Health provides expert care, understanding, and compassion for veterans as they approach the end of life. Their teams support veterans’ personal goals and needs. That includes partnering with primary care providers to offer concurrent care by offering a hospice plan of care alongside curative treatments such as immunotherapy, chemotherapy, and radiation.

To be eligible for hospice care, a patient must have a terminal illness with a prognosis of six months or less if the disease follows its expected course.

The interdisciplinary hospice care team develops a plan of care to meet individual needs for pain management and symptom control, along with addressing psychosocial and spiritual stressors.

Concurrent care may reduce healthcare costs as well as increase hospice utilization. Dr. Jerez-Marte explains that some veterans who enter Suncoast Hospice with concurrent care eventually elect to stop curative treatments.

“Many of these patients come into hospice with the concurrent care approach,” she said. “But then they find out the many modalities the hospice teams have available, including integrative medicine, do take care of their symptoms and their needs. Slowly, they decide not to go for any further aggressive or targeted treatments.”

The success of the VA’s concurrent care initiative has inspired further study.

Pediatric patients may receive concurrent care as part of the Affordable Care Act. Also, the Centers for Medicare Medicaid Innovation is conducting a concurrent care pilot with Medicaid Advantage programs, including Humana, in some Florida counties.

“I think it (concurrent care) is an incredible thing,” said Dr. Jerez-Marte, “I see the future of hospice care trending that way.”

To learn more about Empath Honors, call (727) 467-7423 in Pinellas and Hillsborough counties or, visit EmpathHonors.org or call (855) 843-3935 in Manatee and Sarasota counties, or visit TidewellHospice.org/Veterans.

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[PHOTO CAPTION: Dr. Jasim Jerez-Marte, MD, HMDC]

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