For Immediate Release:
January 14, 2021

MedPAC Votes in Favor of Modifications to the Hospice Aggregate Cap

NHPCO concerned about unintended consequences to access and quality

(Alexandria, Va) – The National Hospice and Palliative Care Organization (NHPCO) was present at today’s virtual public meeting when the Medicare Payment Advisory Commission (MedPAC) voted on recommendations that were introduced at the December 2020 public meeting. Commissioners voted unanimously in favor of eliminating the update to the fiscal year 2021 Medicare base payment rates for hospice for fiscal year 2022 and to wage adjust and reduce the hospice aggregate cap by 20 percent.

NHPCO firmly believes that the recommended modifications to the hospice aggregate cap will negatively impact access to care and potentially drive people to more expensive care settings. NHPCO is especially concerned for people living in rural and underserved areas, as hospice providers have noted that these dramatic cuts could result in unintended hospice closures, particularly in low wage index and underserved areas.

“NHPCO does not support MedPAC’s recommendation to modify the hospice aggregate cap because this approach is overly broad and careless, especially in light of the strain put on providers by the COVID-19 pandemic. If the recommendation is adopted by Congress, it could lead to a decrease in hospice access for patients and families, especially in rural and underserved areas. In the short term, we urge MedPAC to use a targeted approach that will have a higher likelihood of rewarding high quality and improving access,” said NHPCO President and CEO Edo Banach.

“MedPAC’s role is very important but I have serious reservations with the recommendation to cut the hospice program in the midst of a global pandemic.  It is unsafe and potentially harmful to our most vulnerable citizens. Given the unprecedented challenges hospice organizations are already facing while providing care to individuals in the safety of their own home, the policy recommendations could ultimately limit access to high-quality hospice and palliative care services. I would hope for the sake of seriously ill Kentuckians that MedPAC instead focus on minimizing the hardship hospice organizations are experiencing during this incredibly difficult time to ensure that our most vulnerable will have access to the care they deserve. The sweeping recommendations lack nuance and could have very real consequences that limit the ability of hospice organizations to effectively respond to the needs of dying Medicare beneficiaries,” said Liz Fowler, CEO of Kentucky-based hospice provider Bluegrass Care Navigators.

“We urge MedPAC to reconsider recommendations that cut the hospice program. The last year has shown how important high-quality hospice and palliative care services are to vulnerable patients and their families, and we would not want to do anything that would limit access. For the sake of New Yorkers in need of these critical services during this time of unprecedented challenges, we encourage MedPAC to share their insights into ensuring access to the care New Yorkers deserve,” said Rosemary Baughn, Senior Vice President of Visiting Nurse Service of New York Hospice and Palliative Care.

“We do not support MedPAC’s recommendation to wage index and reduce the hospice aggregate cap by 20 percent. Absent reliable data and analysis, it is unclear how such reductions would lead to Medicare savings, increase access to care, or lead to higher quality of care for Californians,” said Cortland Young, Chief Clinical Officer, Central Coast VNA and Hospice.

“We strongly urge MedPAC to reassess their recommendations that make unnecessary cuts to the hospice program. Floridians are in need of these critical hospice services and additional cuts will only compound a host of issues the community is already struggling with, including reimbursement issues related to increased PPE costs and increased staffing costs. Cutting reimbursement at this difficult time would present even more challenges to the hospice community,” said Samira Beckwith, President and CEO of Hope Healthcare.

NHPCO will continue its dialog with MedPAC and is ready to offer assistance to MedPAC to determine current savings to the system when hospice is chosen as an alternative to costlier services, as this analysis is necessary in informing any proposals to change the hospice reimbursement rate or the aggregate cap.

Providers should remember that MedPAC is an advisory body that makes recommendations to Congress. Even with a unanimous vote in favor of the modifications to the hospice aggregate cap, Congress must adopt the necessary legislative changes to put these recommendations into effect. For more detailed information on the recommendations, NHPCO members should see the 12/03/20 Policy Alert on the Regulatory Alerts and Updates page of the NHPCO website.


Jon Radulovic
Communications Team
Ph: 571-412-3973

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