Larry Beresford

A dense, 49-page government document with a mouthful of a title, “Medicare Program; FY 2014 Hospice Wage Index and Payment Rate Update; Hospice Quality Reporting Requirements; and Updates on Payment Reform” was published in the Federal Register on August 7—with huge implications for hospices and their medical directors.

This Final Rule does much more than update the annual Hospice Wage Index. It also covers changes in hospice quality reporting, looming reform of the hospice payment system, and a range of other regulatory issues. Appropriate eligibility for hospice care remains a major focus for the government. But hospices face new requirements in spelling out the primary diagnosis for this eligibility, all related comorbidities and secondary conditions, what is related or unrelated to the terminal prognosis, and how all of the above should be coded on claims forms, described in physician narrative statements and certified by two physicians in their best medical judgment. Some terminal prognoses, notably adult failure to thrive and debility unspecified, will no longer be permitted as primary diagnoses for hospice admissions.

All of this means the role and responsibilities of hospice medical directors are growing. Read much more about the regulatory challenges they now face in the Quarterly. You can also see how AAHPM’s comments on the proposed rule compare to the final regulations in this side-by-side prepared by the Academy’s lobbying and consulting firm, Hart Health Strategies.