For Immediate Release:
December 6, 2019 

NHPCO Policy Alert: NHPCO Comments on December 2019 MedPAC Meeting

(Alexandria, VA) – At todays’ public meeting, the Medicare Payment Advisory Commission (MedPAC) presented the recommendation for a 0% increase in payment rates in FY2021 and revisited previously presented policy options to modify the hospice aggregate cap. The presentation consisted of the following draft recommendation for Congress:

“The Congress should:

      • For fiscal year 2021, eliminate the update to the fiscal year 2020 Medicare base payment rates for hospice, and
      • Wage adjust and reduce the hospice aggregate cap by 20 percent”

NHPCO continues to be concerned about the unintended consequences of the draft recommendation to reduce the aggregate cap on beneficiary access and quality of hospice care. NHPCO staff attended the two-day MedPAC meeting and offered a statement during the public comment period reinforcing concerns which NHPCO first raised back in October.

MedPAC also presented data showing that Medicare beneficiaries using hospice care continues to increase. In 2018 hospice was used by 50.7 percent of those who died, up from 50.0 percent in 2017 and 22.9 percent in 2000.

NHPCO outlined providers’ concerns for the patients and families they serve, specifically related to access, quality, and cost containment. NHPCO comments were as follows:

      • NHPCO is concerned about creating a new barrier to beneficiary access to high quality hospice care that would result by implementing the proposed changes to the aggregate cap, as we hear from providers that urban providers that serve rural areas may reduce their service areas to mitigate cap risk or rural providers with a small census may be forced to go out of business because the aggregate cap has been reduced so dramatically.
      • NHPCO agrees that changes in the aggregate cap may result in delays to accessing hospice care. Median length of stay is already less than 3 weeks. These changes will lead to shorter lengths of stay, and more (and more expensive) acute inpatient care. These are seriously ill patients with high needs for services, many living in rural and underserved areas.  We should be providing more care, earlier.  We strongly believe that a reformed hospice benefit and a pre-hospice community palliative care benefit is essential to addressing these needs.
      • NHPCO would prefer that we focus on a reformed hospice benefit instead of debating an outdated cap mechanism that already deprives people of needed interdisciplinary care and drives people to a care system that does not meet their needs.

“NHPCO does not support today’s MedPAC recommendation to modify the hospice aggregate cap. As we have stressed, without reliable data, it is unclear how such reductions would lead to Medicare savings, increase access to care, or lead to higher quality of care,” said NHPCO President and CEO Edo Banach. “NHPCO shares MedPAC’s goals, but this approach appears overly broad and likely to lead to a decrease in hospice access for patients and families. In the short term, we urge MedPAC to use a targeted approach that will have a higher likelihood of rewarding high quality, punishing low quality, and increasing access.”

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.


Media Contact:
Jon Radulovic
VP, Communications
Ph: 703-837-3139