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Long awaited Hospice Payment Reform goes into effect on 1/1/2016

Posted by Pam Ware | | filed under: , , , , ,
For years the Center for Medicare Services, CMS, has been talking about reforming the hospice payment. Since the hospice benefit was carved out in 1983 there have been no significant changes in reimbursement.

Rate Information obtained for National Hospice and Palliative Care

 For years the Center for Medicare Services, CMS, has been talking about reforming the hospice payment.  Since the hospice benefit was carved out in 1983 there have been no significant changes in reimbursement. The hospice benefit has (4) levels of care: Routine, Respite, Continuous Care, and General Inpatient.  Hospice has seen some reinterpretations in our regulations but we have not seen a major structural change. An example of a reinterpretation was when CMS decided that hospice was responsible for all costs related to the palliation of the terminal diagnosis and related to the 6 month prognosis. This change was officially made on Oct 1, 2014. Prior to this, and you may still see articles referring to the old way, hospice was responsible for all costs related to the palliation of the terminal diagnosis and related conditions.

What CMS has been grappling with is what I would refer to as payment fairness.  The cost to care for patients costs each hospice more at the beginning and at the end of care. How do you adjust hospice payment to reflect this? After many years of conversations, the inverted “bell shaped curve” will come into effect on Jan 1, 2016. This will apply to Routine Home Care only.

County

Routine Home Care Rate 10/1/15-12/31/2015

Routine Home Care Rate effective 1/1/2016

Days 1 - 60

Routine Home Care Rate Effective 1/1/2016

Days 61 on

Service Intensity Add On per hour for a maximum of 4 hours (last 7 days of life only)

Adams

$166.66

$192.35

$151.16

$40.53

Boulder

$160.86

$185.65

$143.26

$38.41

Larimer

$155.82

$179.83

$141.32

$37.89

Weld

$157.95

$182.33

$143.29

$38.41

Rates taken from National Hospice and Palliative Care  FY 2016 Hospice Wage Index Table

This rate reform applies to Routine Home Care only. The patient’s home can be an assisted living, a skilled nursing facility, or a private home. It does not affect the Respite, Continuous Care, or General Inpatient rates since these are short term in nature. The Service Intensity Add On is an hourly rate paid for a RN and/or Social Worker who are at the bedside delivering skilled services that are care planned. This cannot be used for unskilled services such as sitting with the patient so the spouse can go grocery shopping.

Some hospices are worried that this is a significant rate cut disguised as rate reform. It will be a rate cut for those hospices that have long lengths of stays and/or do not provide a lot of skilled care. For hospices that are close to the National Average for both their average length of stay (73 days) and median length of stay (19 days) and are providing skilled visits by an RN and a social worker in the last 7 days of life this actually comes close to our current rate structure if not more. Consumer beware – do not settle for less skilled care, medications, supplies, or durable medical equipment because “Medicare cut our rate”. For most hospices, this is not the case. For those that will see less revenue, their median length of stays may suggest that they are caring for a lot of chronically ill not terminally ill with a prognosis of 6 months or less.

As a family member told me recently, “not all hospices are the same”.

Submitted By:

Pam Ware, MSW, LCSW CEO of Front Range Hospice

For more information, please call 303-957-3101

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Patti Welfare
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