MedPAC's January Meeting Transcript: Reforming Medicare's Hospice Benefit

The transcript of the January 9 MedPAC (Medicare Payment Advisory Commission) is available here (PDF). Discussion of recommendations for changes to Medicare's hospice benefit begin on p. 257. We have posted the recommendations that were proposed at the November meeting previously. These recommendations were slightly modified and voted on at the January meeting. Some highlights:

The current Medicare payment system was described as a linear system, MedPAC is proposing a new system that would resemble U-shaped curve, with higher rates paid at the beginning and end of a hospice episode, which would more accurately reflect hospice's costs. The recommendation was discussed in detail and roughly reads: 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 the episode increases; include a payment system for the higher costs associated with patient death at the end of episode; implement the payment system changes in 2013 with a brief transitional period.

They state the payment changes should be implemented in a budget neutral manner, considerable discussion was later given to whether starting from a budget neutral position was desired.

Another recommendation addressed the need for greater accountability. This recommendation requires a hospice physician or advanced practice nurse to visit the patient for recertification and to include a brief narrative describing clinical basis for patient's prognosis. Stays exceeding 180 days would be medically reviewed when hospice stays longer than 180 days make up 40 percent or more of a hospices cases. (There is discussion later in the transcript that advises leaving the question of who conducts the review vague for now, also it would be an external review.)

The final recommendation combined two others on the need for greater data collection and read:

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 should be collected from claims as a condition of payment and from hospice cost reports.

After the modified recommendations were presented by MedPAC, there was discussion about the policy goals of the recommendations. The recommendations were then voted on and will be included in the March report, after the March 12-13 meeting.

A slide presentation shown at the meeting is also available (PDF).