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After 30 Years, Changes To Medicare Reimbursement Of Hospice Care

Courtesy Wikimedia Commons
Courtesy Wikimedia Commons

A new payment system would change the way hospice providers are reimbursed for care provided to dying patients.

The payment system, proposed in May by the Centers for Medicare and Medicaid Services (CMS), would establish a two-tiered payment model for patients receiving the routine home level of hospice care, based on length of stay. It is scheduled to go into effect by early fall.

It would be the first major change to hospice payments in nearly 30 years, establishing a higher payment rate for a patient’s first 60 days in hospice and a lower rate thereafter.

Bipartisan legislation to test the new model before national implementation, H.B. 3037, was introduced Tuesday by Reps. Tom Reed, R-N.Y., and Mike Thompson, D-Calif. It calls for a one-year pilot program of only one payment jurisdiction.

Jonathan Keyserling, NHPCO
Jonathan Keyserling, NHPCO

The National Hospice and Palliative Care Organization enthusiastically supports the bill, because members are concerned that payment reform will be implemented too quickly and without proper testing. Most hospice programs rely primarily on Medicare reimbursement.

“This legislation seeks to have CMS test the new payment methodology that they intend to enact October 1. The hospice community is very concerned about CMS, as well as their contractors and software vendors, who also have to make changes to facilitate a smooth transition to the new methodology,” said Jonathan Keyserling, NHPCO senior vice president for health policy and legal counsel. “We’re very concerned that CMS does not have the infrastructure or procedures in place to make a smooth transition. We would like to see the new system put in place as soon as it is ready.”

In addition to payment reform testing, H.B. 3037 would direct CMS to conduct a medical review of providers with troubling survey results, such as a high percentage of live discharges between 120 and 180 day stays or patients receiving no skilled visits in the last seven days of life.

The bill also calls on CMS to require hospitals to provide patients being discharged who are likely to need hospice care with a list of Medicare-certified hospices serving their area.

Reps. Reed and Thompson were not immediately available for comment.

Hospice care aims to provide comfort care and pain management rather than aggressive treatments for terminally ill patients with six months or less to live. Hospice is most often used when curative treatments are no longer effective.

On Tuesday, hundreds of hospice advocates gathered on Capitol Hill to voice their concerns as part of the Hospice Action Network’s Advocacy Intensive.