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MedPAC Recommendations Alert

MedPAC Finalizes Hospice Benefit Reform Recommendations

To:         NHPCO Members
From:    NHPCO Public Policy Team
Date:    January 9, 2009

The Medicare Payment Advisory Commission (MedPAC) met today to review and vote upon recommended changes to the Medicare hospice benefit. These recommendations ask Congress, and/or other governmental bodies, to undertake actions that would lead to payment system reforms, actions that can be taken to improve accountability in the hospice benefit, and additional data needs. The commissioners voted to finalize the recommendations (listed below) and are expected to forward them to Congress in the MedPAC’s March Report. 

The MedPAC recommendations are just the starting point in the process that Congress will undertake to review and modernize the Medicare hospice benefit. Other considerations that could be important to federal representatives include outside research, issues impacting the hospice community beyond what was addressed in the MedPAC recommendations, and grassroots advocacy from the hospice community.  It is important to note that MedPAC does not have the authority to unilaterally act on their recommendations. They can only advise federal agencies such as CMS and work with Congress toward revision and enactment.

NHPCO and other key stakeholders in the hospice community have joined together to release a consensus statement responding to MedPAC’s recommendations. The press release and consensus statement, released January 8, 2009, is available on the NHPCO Web site.

MedPAC’s Medicare Hospice Benefit Reform Recommendations*

1. The Congress should direct the Secretary to change the Medicare payment system for hospice to:

  • relatively higher payments per day at the beginning of the episode, and relatively lower payments per day as the length of stay increases,
  • include a relatively higher payment for the costs associated with patient death at the end of the episode, and
  • implement the payment system changes in 2013, with a brief transition period.

These payment system changes should be implemented in a budget neutral manner in the first year.

2a. The Congress should direct the Secretary to:

  • require that a hospice physician or advanced practice nurse visit the patient to determine continued eligibility at 180 days and at each subsequent recertification, and attest that such visit took place,
  • require that certifications and recertifications include a brief narrative describing the clinical basis for the patient’s prognosis, and
  • require that all stays in excess of 180 days be reviewed by the applicable medical director of the Medicare claims processing contractor for hospices for which stays exceeding 180 days make up 40 percent or more of their total cases.

2b. The Secretary should direct the OIG to investigate:

  • the prevalence of financial relations between hospices and long-term care facilities such as nursing facilities and assisted living facilities that may represent a conflict of interest and influence admissions to hospice,
  • differences in patterns of nursing home referrals to hospice,
  • the appropriateness of enrollment practices for hospices with unusual utilization patterns (e.g., high frequency of very long stays, very short stays, or enrolment of patients discharged from other hospices), and
  • the appropriateness of hospice marketing materials and other admissions practices.

3.  The Secretary should collect additional data on hospice care, and improve the quality of all data collected, to facilitate the management of the hospice benefit. Additional data could be collected from claims as a condition of payment, and from cost reports.

* Please note that the above recommendations are based on the initial draft voted upon by the Commissioners and could slightly, but not substantively, change by the time the final version is released next week on the MedPAC Web site. Interested parties should check the MedPAC Web site for the meeting transcript in 3-5 days.

Any questions should be directed to Angie Truesdale, Director, Public Policy, at atruesdale@nhpco.org.