Advocacy

MedPAC Suggests Changes to the Medicare Hospice Benefit

At its November 6 meeting, the Medicare Payment Advisory Commission (MedPac) heard staff recommendations for changes to the Medicare Hospice Benefit. The staff recommended changes to the payment system, additional requirements for certification and recertification, collection of additional visit data, and an OIG investigation of financial arrangements between nursing homes and hospices. The MedPAC commissioners plan to vote on the recommendations at their January meeting.

Access the slides of the staff presentation. (http://www.medpac.gov/transcripts/20081104_Hospice_final_public.pdf) and the full meeting transcript (http://www.medpac.gov/transcripts/1106-1107MedPAC%20final.pdf hospice portion begins on p. 170). 

The draft recommendations by MedPAC staff were as follows:

1)  Change payment rates to pay more for beginning and end of stay, less for days in the middle.

The Congress should change the current payment system to reduce payments per day as the length of the episode increases. The revised payment system should include a payment adjustment to reflect hospices' higher costs associated with patient admission and death at the end of the episode.

The goal is to adjust the payment rate to reflect the higher costs of care in the first and last days of an episode and to decrease the economic incentive for very long lengths of stay. The staff proposed setting payment rates in a budget neutral manner so that aggregate payments under the new approach would be the same as aggregate payments under the current system. However, individual hospices would find that their total payment changed, with hospices with shorter stays benefiting and hospices with longer stays losing. Modification of the payment rate requires legislative action by Congress.

2) Strengthen requirements for certification and recertification of a patient's eligibility.

The Congress should direct the Secretary of Health and Human Services (HHS) to:

• require that a hospice physician or advance practice nurse personally visit the patient to determine continued eligibility at 180 days and at each subsequent recertification and attest that such visits took place
• require that certifications and recertification include a brief narrative from the hospice physician describing the clinical basis for the patient's prognosis
• for hospices with an average length of stay greater than 120 days, require that all stays in excess of 180 days be reviewed by the applicable medical director of the Medicare claims processing contractor

3) OIG investigation of financial relationships between hospices and nursing facilities

The Secretary (of HHS) should direct the HHS Office of Inspector General (OIG) to investigate the prevalence of financial relationships between hospices and nursing facilities that may represent a conflict of interest and influence admissions to hospice, differences in patterns of nursing home referrals to hospice, and the appropriateness of hospice marketing materials.

4)  Additional Data Collection on Claims and Cost Reports

• As a condition of payment, the Secretary of HHS should require that hospices report information on all visits provided to the patient on hospice claims, including length of visit.
• The Secretary of HHS should change cost reports to reflect new data collection on hospice claims, add new data fields to capture the full range of hospice revenues in order to provide a more accurate picture of hospices' financial performance, and increase the accuracy of cost report data through audits or other processes so that these data can be used in setting, adjusting, or rebasing payments, as warranted.

AAHPM's Public Policy Team has been closely engaged with MedPAC and with other organizations (NHPCO, HPNA) in monitoring and proactively influencing this important policy discussion. Academy members Laurel Coleman of Beacon Hospice, Manchester, ME, Joan Harrold of Hospice of Lancaster, Lancaster, PA and Barry Kinzbrunner of Vitas Healthcare Corporation, Miami, FL participated on the MedPac Hospice Expert Panel which met with James Mathews, Deputy Director, MedPAC on October 6 in Washington. Medpac convened the panel in order hear directly from hospice providers about how hospices were responding to the Medicare Hospice Benefit.

Questions may be directed to info@aahpm.org