Wednesday, May 21, 2008

Discussing the Future of Hospice Care

A MedPage Today column by David B. Nash, M.D., M.B.A., F.A.C.P.; JoAnne Reifsnyder, Ph.D., A.P.R.N. (DISCLOSURE: Dr. Reifsnyder has been a panelist and expert for HFA) discusses recent developments in end-of-life care and what these changes could mean for hospice providers. The authors talk about the roles palliative and hospice care play for patients, and trends on the horizon.
Increasing access to palliative care in the home or other residential settings. Many hospice experts argue that removing the typical eligibility requirement of a six-month prognosis would meet many more patients' needs for palliative care and create access for patients with chronic illnesses.

Because payment for hospice is largely government-funded through Medicare and state Medicaid programs, however, myriad economic and public relations questions must be addressed.


Hospice Rule Changes. Two issues are driving increased CMS scrutiny of the hospice industry: First, the dramatic growth in CMS payments to hospice and second, suspected fraud and abuse in the hospice industry.

Most significant among the imminent changes to the Medicare hospice benefit are a new emphasis on quality assessment and performance improvement, a first step toward what experts agree will be a public reporting initiative and, eventually, a pay-for-performance design for hospice reimbursement, and a new emphasis on leadership at the board level.


Compression of Reimbursement. Noting the hospice industry's exponential rate of growth, CMS has signaled that reimbursement reforms including across-the-board per diem rate cuts and greater scrutiny of claims are on the horizon. And it's unlikely that there will be any help for those hospices that exceed the annual, aggregate per-beneficiary cap on reimbursement -- an increasing problem with growing enrollment of longer-stay patients.

General Inpatient Care and Hospice-managed Inpatient Units. Many hospices now own and operate small, freestanding or co-located facilities where they provide residential and acute-level care to hospice patients. As development of these units has accelerated, utilization of the general inpatient (GIP) level of the Medicare hospice benefit has increased.

CMS is tracking this trend, and has noted a growth in hospice-related expenditures for GIP between 2001 and 2005. Hospices should expect to see greater regulatory scrutiny of utilization.


Hospice in Nursing Homes. Hospices routinely bring the hospice model and service package to residents of nursing homes, providing support to the residents' families and nursing home staff in addition to the resident himself.