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Hospice groups fight Medicare rate cut
Cuts were supported by Bush administration
[Editor's note: Medical Ethics Advisor will update this story in the April issue. Prior to press time, NHPCO secured a one-year moratorium on cuts in the Medicare Hospice Benefit via President Barack Obama's signing of The American Recovery and Reinvestment Act of 2009.]
Hospice providers and the organizations that represent them are attempting to blunt a cut to the Medicare hospice benefit, imposed by the Bush Administration last year, that took effect Oct. 1, 2008.
In the consensus statement passed by both the U.S. House of Representatives and the Senate in mid-February, when the legislation headed into the conference process to determine the final elements of the package between the House and Senate, the National Hospice and Pallative (NHPCO) said the moratorium provision "is critical to protecting thousands of hospice jobs and preserving access to quality end-of-life care for patients nationwide."
Originally, the provision passed in the House version of the Obama administration-supported stimulus package included language calling for a one-year moratorium on the elimination of rate cut to the Medicare hospice benefit.
Jon Keyserling, vice president of public policy and counsel of NHPCO in Alexandria, VA tells Medical Ethics Advisor that NHPCO "has pulled together a broad cross section of membership organizations that represent various elements of the hospice and palliative care community."
"And we have, where appropriate, tried to develop a consensus around specific topics, so that the hospice community speaks with one voice," Keyserling says.
Although that coalition has issued numerous consensus statements, the group specifically issued a statement in early January in response to anticipated recommendations made by MedPac, an independent oversight body for Medicare and Medicaid.
The consensus statement, issued Jan. 8, notes that "Since the inception of the Medicare Hospice Benefit in 1982, hospice has grown into a $10 billion industry that last year alone served more than 1.4 million dying Americans and their family caregivers."
As the group tracked the progress of the stimulus package through both bodies in early February, Keyserling at that time told MEA that as the Senate considered its version of the stimulus package, there had been "a number of amendments offered on the Senate floor to the package.
"Because we are in the House-passed version, but not yet in the Senate-passed version, we're anticipating and we're hopeful that we will be added to the Senate package," he tells MEA.
Keyserling says the rate cut would result in the loss of "up to 3,000 jobs" nationwide.
"Now, that's 3,000 jobs in the first year," he says. "We are already hearing from hospice programs all across the country that they are cutting back service areas; that they are letting staff go and not hiring additional staff; and ultimately this is going to impact patients and their families. And that's our primary concern — that patients and families continue to have access to high-quality end-of-life care."
Asked why the Bush administration via HHS and CMS wanted the rate cut for hospice care funded by Medicare, Keyserling tells MEA, "I have been bewildered by the previous administration's actions in this area. And the only public explanation we have heard is CMS and the administration wanted to reduce hospice expenditures, and that just strikes me as odd, because, one: The increase in expenditures on hospice services … has been driven largely by an increased portion of Medicare beneficiaries accessing the benefits."
Keyserling also says that two previous CMS administrators "actively promoted the notion that physicians ought to feel comfortable referring patients to hospice, and patients should feel very comfortable accessing the Medicare hospice benefit."
For millions of Americans every year, "dying is not an option," Keyserling says. "It is going to occur. It's part of the natural cycle of life, but the question of where and how you are going to be served in that process is an option, and it should remain an option for patients and families."
The MedPac consensus statement
Among the elements emphasized in the consensus statement from the various hospice organizations regarding any changes in the Medicare Hospice Benefit was what Keyserling termed "the real need to collect and to analyze and to understand the comprehensive data that is needed to direct potential payment reform."
One recommendation made by MedPac in November suggested that the HHS Secretary "should direct the OIG to investigate the prevalence of financial relationships between hospices and nursing facilities that may represent a conflict of interest and influence admissions to hospice, differences in patterns of nursing home referrals to hospice, and the appropriateness of hospice marketing materials."
According to Keyserling, "I think the MedPac focus is to head off potential problems. I don't know that they have identified any particular practices but are concerned about the appearance of impropriety."
The HHS Office of Inspector General (OIG) is expected to issue the second part of a report first issued last year, with the first part primarily addressing the demographics of hospice services in the long-term care setting, he says.
Those actual recommendations are expected to be released in that group's March report to Congress, Keyserling says.
As for changes in payment methodology, thus far MedPac has made a recommendation that any change to be made not occur before 2013, Keyserling says.