A message from Edo Banach.
March 15, 2019
The Medicare Payment Advisory Commission’s (MedPAC’s) March 2019 Report to Congress was released today. To view the report, click here.
NHPCO leadership met with MedPAC staff in January 2019 and reviewed the chapter on hospice that was released today. We provided important information and context regarding hospice care delivery in the U.S. We are grateful for MedPAC’s commitment to hospice issues and willingness to discuss both the contributions and concerns of our community, and we appreciate the opportunity to serve as a trusted resource.
As we have seen in previous MedPAC reports, the March report contains a review of issues that the Commission has already discussed in past reports. There are additional recommendations included in the March 2019 report that are of concern to the hospice provider community. NHPCO offers the following comments in response to this March 2019 report’s hospice chapter.
Hospice Access and Support
We are pleased to see that more than 50 percent of Medicare beneficiaries who died in 2017 received hospice care. About 1.5 million Americans – and their family caregivers – were able to avail themselves of the person-center, interdisciplinary care that the nation’s nearly 4,500 hospice providers offer to those facing a life-limiting illness. Growth in beneficiary access has also been accompanied by an increase in hospice providers.
In reflecting upon individuals served by hospice, NHPCO wishes to raise awareness of the ongoing support that family caregivers are offered through bereavement support that continues to help individuals coping with grief move beyond the shadow that a loved one’s death often casts. The ongoing impact, felt long after reimbursement has ceased, is one of the holistic care practices that sets hospice apart from other medical disciplines.
NHPCO believes that the $17.9 billion spent on care for the dying is an expenditure reflecting necessary and appropriate compassionate service that all individuals deserve and should be a priority in our nation’s health care delivery system. The revised payment system for routine home care that began in January 2016 is an example of change that hospice providers continue to implement. NHPCO looks forward to ongoing data collection to show how the availability of additional registered nurse and social worker visits increases support during the last seven days of life.
The MedPAC Commissioner’s attention on the demographics of beneficiaries served by hospice care represents the importance understanding of how hospice engages with varies populations. NHPCO is anxious to review the analysis of the reported data that includes age, sex, and ethnicity. Hospice should be available in communities that are underserved and by populations that underutilize the care provided. There are areas of improvement that hospice providers need to focus on to ensure they are reaching all those individuals that benefit from our person-center philosophy of care.
Length of Stay
While there has been focus on long length of stay among Medicare beneficiaries receiving hospice care, which is understandable, it should be noted that far too many patients and their families (the hospice “unit” of care) are not receiving the full benefit of hospice services when they are referred too late in their disease trajectory. This issue has plagued patients and families for years. At the heart of this issue is honoring the wishes of beneficiaries and their family caregivers and giving them opportunity to consider and express their wishes throughout the health care system. The need for Medicare’s involvement in addressing this issue is unquestionable and must be included in any discussion of service length.
MedPAC’s discussion of margins among hospice providers reflects the complexity of this issue in the field.
There is no doubt that some of the providers have margins that are high, even when accounting for services – such as bereavement – that are required but not separately reimbursed. However, NHPCO has stressed to MedPAC that quality of patient care – rather than days or margins – should be paramount.
NHPCO is committed to working with MedPAC to assure that no hospice provider puts margins ahead of patient quality of care, and is also committed to working with MedPAC, Congress and the Administration to evolve the hospice benefit to assure a greater focus on the quality of care and on meeting patient and family needs.
Proposed Two Percent Cut
As MedPAC has recommended a zero percent update to the hospice payment rates since 2014, for many providers in the hospice community, MedPAC’s current proposal to reduce the fiscal year 2020 Medicare payment rate by two percent is the issue that stands out in the March report. A suggestion NHPCO offers to MedPAC Commissioners would be to replace the proposed two percent cut across the board to a two percent cut that would be imposed upon providers that failed to report quality metrics – this would be in addition to current policy for failure to participate in quality data collection.
There is an acknowledged desperation among policymakers to solve the nation’s fiscal issues and preserve Medicare for future generations; however, a two percent cut to hospice reimbursement may have unintended consequences affecting access to hospice and quality of care and would likely increase overall Medicare spending by driving patients to more expensive and less appropriate care settings.
NHPCO recognizes and supports the need for all hospice programs to perform their roles utilizing the highest standards of care and an enduring commitment to high-quality compassionate care for people they serve.
Given the complexity of care provision to the dying, extra care should be undertaken to ensure that any suggested changes to the Medicare Hospice Benefit must be measured and exclusively informed by validated data.
The hospice community stands ready to work with MedPAC and any responsible policy-making body to improve the delivery and experience of end-of-life care in this country.
Charles Diener says
I am concerned there is a proposed 2 percent cut to the Medicare hospice benefit. This will increase the gap in the actual cost of care and services we provide, as well as the payments received, creating an additional loss of at least $50,000 to Hospice Care of the Lowcountry in 2020.