CMS proposes 1.1% payment bump for hospices

by | May 10, 2013

Hospices would receive a $180 million boost from Medicare in the next fiscal year under a proposed rule issued Monday (PDF).

The proposed rule would provide a 1.1% increase in fiscal 2014 payments to hospices, which treated more than 1.3 million Medicare beneficiaries in the past fiscal year, according to the CMS.

That boost is the result of the agency cutting a 1.8% increase by 0.7 of a percentage point to account for an ongoing change in the way hospice rates are calculated. That cut is part of seven-year phase out of an old wage index to a more “accurate method for determining hospice payments,” according to a CMS fact sheet. Such reductions are scheduled to continue through fiscal 2016.

A coding change included in the proposed rule would direct hospices to discontinue using certain nonspecific diagnoses, or nonprincipal diagnoses, such as “debility,” in their billing codes. Instead, hospices should use billing codes for the principal diagnosis based on the underlying condition that is the main focus of the patient’s care.

“CMS is interested in gaining a better understanding of those who are served by the Medicare hospice program,” the fact sheet said about the change.

The proposed rule also would change the quality reporting program for hospices, under which they began to face penalties in fiscal 2013. The rule proposed that beginning in fiscal 2016 hospices’ would replace reporting on a pain management measure and a structural measure with two other measures.

Also in fiscal 2016, the CMS proposed requiring hospices to collect and submit new patient-data forms. The Hospice Item Set would aim to track standardized aspects of hospice patient care at admission and discharge. Data collection would begin July 1, 2014, and affect payments beginning in fiscal 2016.

A new quality-reporting requirement of the rule proposed for fiscal 2017 is a hospice experience-of-care survey for families and friends of hospice patients. The survey would track hospice provider communications with patients and families; hospice provider care; and overall rating of hospices. The CMS plans to include the final requirements for that survey in its fiscal 2015 rulemaking.

Additionally, the proposed rule includes updates on Medicare hospice payment reform efforts, including a discussion of reform model options; highlights from recent reform research; and an update on data collection efforts.

The latest rates come amid rapid growth in Medicare beneficiary use of hospices from 513,000 in fiscal 2000 to more than 1.3 million in fiscal 2012. Similarly, CMS spending on hospices has risen sharply from $2.9 billion in fiscal 2000 to $14.7 billion in fiscal 2012.

The increase is partly due to an increased average length of stay for beneficiaries, according to the CMS, from 54 days in 2000 to 86 days in fiscal 2010, up nearly 60%.

From: Modern Healthcare

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