Hospice Advocates Bring their Voices to Washington, DC
For Immediate Release
June 16, 2023
NHPCO and HAN Help Ensure Provider Concerns are Heard on The Hill and at CMS
(Alexandria, VA) – More than 70 hospice and palliative care advocates from across the country met with over 130 congressional offices last week to discuss key legislative and regulatory priorities for ensuring and expanding access to hospice and palliative care. The meetings were part of Hospice Action Week, hosted in Washington, DC by the National Hospice and Palliative Care Organization (NHPCO) and its advocacy affiliate, the Hospice Action Network (HAN).
These congressional advocacy actions came a week after NHPCO filed detailed comments on the Centers for Medicare and Medicaid Services’ (CMS) Fiscal Year (FY) 2024 Hospice Wage Index and Quality Reporting Proposed Rule, demonstrating the importance of both legislative and regulatory advocacy for protecting and improving hospice and palliative care. In addition to the full comments, a summary of NHPCO’s recommendations on the proposed rule is available on its website.
The congressional meetings and the FY 2024 comment letter addressed key issues impacting the hospice and palliative care community, including:
Reimbursement: For providers to continue delivering hospice care that Americans increasingly choose, and which has been recently demonstrated to improve patient and family outcomes while saving money, Medicare reimbursement must support delivery of those services. Reimbursement was a focus of both the comments on the FY 2024 Hospice Wage Index proposed rule and Hospice Action Week. Noting that the hospice market basket calculation used to predetermine hospice reimbursements ahead of each fiscal year has resulted in rates that have not kept up with actual market basket increases, NHPCO recommended that CMS use its special exception and adjustment authority to make a one-time retrospective adjustment of 3.7% for the combined FY 2021 and FY 2022 market baskets, in addition to the FY 2024 market basket adjustment of 2.8%, to ensure Medicare payments more accurately reflect the cost of providing hospice care today.
Program Integrity: In keeping with our longstanding efforts on program integrity, both NHPCO’s comments on the FY 2024 Hospice Wage Index proposed rule and the Hospice Action Week advocates’ meetings with congressional offices included a focus on hospice program integrity and fraud prevention. In the comment letter, NHPCO reiterated strong support for all efforts by CMS to address fraudulent behaviors that abuse the hospice Medicare benefit to defraud the system and harm patients. In Washington, hospice and palliative care advocates asked their Senators and Representatives to use their oversight authority to ensure CMS does everything possible to prevent fraud in the hospice system. We continue to advocate for 34 program integrity recommendations we made in January.
Workforce: As noted in the NHPCO comment letter, “Hospice providers are now seeing critical staffing shortages among nurses, social workers, aides, and other members of the interdisciplinary team…Providers report for 2022 nursing wages increased by as much as 23%, aide wages increased by as much as 12% and wages of other members of the interdisciplinary team increased by 5-6%… Hospices are not well positioned to compete with hospitals, staffing agencies, and other post-acute healthcare providers to recruit qualified care team members without significantly increasing their compensation costs.” These challenges speak to the need for reevaluating hospice reimbursement as outlined above. Additionally, advocates meeting with congressional offices recommended reintroduction of the Palliative Care & Hospice Education Training Act (PCHETA), a bill introduced in several recent congresses with broad, bipartisan support backed by NHPCO and HAN, which would establish a national approach to research and education to advance hospice and palliative care medicine.
Community-based Palliative Care: The hospice and palliative care advocates used congressional visits as an opportunity to discuss the importance of advancing a model of Community-based Palliative Care. Within days, U.S. Senators Jacky Rosen (D-NV), John Barrasso (R-WY), Tammy Baldwin (D-WI), and Deb Fischer (R-NE), co-chairs and co-founders of the bipartisan Senate Comprehensive Care Caucus, introduced the bipartisan Expanding Access to Palliative Care Act (S.1845), which would require the Center for Medicare and Medicaid Innovation (CMMI) to develop a Community-based Palliative Care demonstration.
CMS Requests for Information: NHPCO’s comment letter included detailed responses to two Requests for Information included by CMS in the FY 2024 Hospice Wage Index proposed rule, including recommendations related to:
- Advancing health equity
- Addressing the number of hospices that do not bill for the required four levels of care
- Considering the issues with expensive end-of-life treatments, such as blood transfusions, palliative radiation and chemotherapy, and dialysis
- Exploring options for concurrent curative and hospice care in specific patient situations
- Improving available information from other Medicare providers about spending when the patient is enrolled in hospice
- Adding codes to track the provision of services through telehealth and codes specifically for chaplain visits
- Improving accuracy of ownership data in Care Compare and other government-run systems
Hospice Action Week also featured a meeting of the NHPCO Council of States, a network of leaders of state hospice and palliative care organizations from across the country. The Council of States discussed state and national policy issues of interest to hospice and palliative care providers and the role of state organizations in addressing the issues noted above.
The National Hospice and Palliative Care Organization (NHPCO) is the nation’s largest and oldest membership association for providers who care for people affected by serious and life-limiting illness. Our members deliver and expand access to high-quality, person-centered interdisciplinary care to millions of Americans. NHPCO provides education and resources to support that mission. Together with our advocacy partner, the Hospice Action Network (HAN), we serve as the leading voice advancing public policy to improve serious-illness and end-of-life care, while our CaringInfo program provides free resources to educate and empower patients and caregivers. nhpco.org