First medicare demonstration of concurrent provision of curative and hospice services for end-of-life care

Hospice developed in the United States in the 1970s as a way to address unmet needs for endof- life care: support for pain and symptommanagementprovided in the location and manner that the patient and family prefer. In Europe and Australia, hospice is available from the time of diagnosis of an advanced lifelimiting illness onward, but in the United States, the Medicare hospice benefit restricts eligibility for these services to patients who no longer receive curative treatment. We provide background and analysis of the first Medicare hospice demonstration in 35 years that will test the concurrent provision of curative and hospice services for terminally ill individuals with a life expectancy of sixmonths or less. This demonstration is a harbinger of potential policy changes tohospiceandpalliative care in the United States that could reduce barriers to end-oflife care that aligns with patient and family preferences as the demand for care increases with an aging population. © 2013 American Public Health Association.