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Hospice-related Changes in Health Care Reform Law
Market basket cuts and productivity.
Incorporates a productivity adjustment reduction into the market basket update beginning in fiscal year (FY) 2013,
A market basket reduction of 0.3% will be implemented for FY 2013 to FY 2019.
National Hospice and Palliative Care Organization (NHPCO) in Alexandria, VA, has confirmed that the actual impact of these cuts will be $6.8 billion, rather then the $7.8 billion previously reported.
Hospice payment reforms.
The secretary of the Department of Health and Human Services (HHS) is required to collect data and update Medicare hospice claims forms and cost reports by 2011.
Information collected will be used to implement revisions to hospice payment rates.
After January 2011, a hospice physician or nurse practitioner must have a face-to-face encounter with each hospice patient to determine continued eligibility prior to the 180th-day re-certification.
A medical review of certain patients in hospices with high percentages of long-stay patients will be conducted.
Medicare concurrent care demonstration program.
Three-year demonstration program will allow patients who are eligible for hospice care to also receive other Medicare covered services while remaining on hospice care.
Up to 15 hospice programs in rural and urban areas will participate.
No date set for implementation of program or selection of sites for participation.
Curative and palliative care for children.
Allows children enrolled in Medicaid or Children's Health Insurance Program to receive hospice services without forgoing curative treatment related to a terminal illness.
Effective date is 2013.
Independent Payment Advisory Board.
Creates an Independent Payment Advisory Board that will present Congress with comprehensive proposals to reduce excess cost growth and improve quality of care for patients.
NHPCO and a large group of other patient, provider, and health advocacy groups opposed this provision, which will remove Congressional authority over Medicare and place it with political appointees.
Hospice value-based purchasing/promoting high value health care.
Gives HHS the authority to test value-based purchasing programs for long-term care providers, include hospice, no later than January 2016.
The program that applies to hospice is in the preliminary stages, according to NHPCO. There is a six-year time line to launch it.
Requires hospice to report on quality measures determined by HHS and endorsed by the new quality measures consensus-based entity or face a 2% reduction in the market basket update.
Although there is no specified time frame in the act, the new quality measures consensus-based entity will have to consider hospice quality measures in 2011.
Measures will be published in October 2012 for reporting to begin in FY2013. (For more information about the quality measures consensus-based entity, go to www.ssa.gov/OP_Home/ssact/title18/1890.htm.)
Nationwide program for background checks.
Establishes a national program for long-term care facilities and providers to conduct screening and criminal and other background checks on prospective direct access patient employees.
This is an extension of a pilot program established under the Medicare Prescription Drug Improvement and Modernization Act of 2003. The pilot program did not include hospice providers, but the new program does.
Funding is authorized for FY 2010 through FY 2012.
Because individual states have an application program and must sign agreements, the national program might take up to a year or more to implement.
Advancing research and treatment for pain care management.
Authorizes an Institute of Medicine Conference on Pain Care to evaluate the adequacy of pain assessment, treatment, and management.
Establishes a grant program to enhance clinical research on the causes and treatments of pain.
Education and training programs in pain.
HHS secretary authorized to make grants available to hospices and other providers to develop and implement pain care education and training programs for health care professionals.
Funding is authorized for FY 2010 through FY 2012.
Source: National Hospice and Palliative Care Organization, Alexandria, VA. A Closer Look at the Health Care Reform Provisions Impacting Hospice. March 26, 2010.
For more information about health care reform and its effect on hospice, contact:
Carla Braveman, BSN, RN, MEd, CHCE, President and Chief Executive Officer, Big Bend Hospice, 1723 Mahan Center Blvd., Tallahassee, FL 32308. Telephone: (850) 878-5310. E-mail: firstname.lastname@example.org.
Jonathan Keyserling, JD, Vice President of Public Policy, National Hospice and Palliative Care Organization, 1700 Diagonal Road, Suite 625, Alexandria, VA 22314. Telephone: (703) 837-1500. Fax: (703) 837-1233. E-mail: email@example.com.
For information about quality and outcome measures for hospice, go to:
Florida Department of Elder Affairs. Site contains a copy of the form used by Florida hospices to report data Web: elderaffairs.state.fl.us/english/hospice.php. Scroll down page and under "Hospice Data Submission and Annual Reports" select the link for "hospices unable to use online form" to download the Excel form.
PEACE Project. Go to www.thecarolinascenter.org. Under "who we serve," select "Hospices," and then "Hospice PEACE project." At the bottom of the page select "Resources page" to find recommended outcome measures, tools for collection and reporting of data, and recommendations to help hospices prepare for outcome reporting.
For more information about changes faced by hospice, contact:
Renee Hahn, Chief Financial Officer, Harry Hynes Memorial Hospice, 313 S. Market Street, Wichita, KS 67202. Telephone: (316) 219-1711. Fax: (316) 265-6066. E-mail: RHahn@hynesmemorial.org.
A few of the companies that provide web-based billing and medical records systems are:
Care Converge, Fishkill, NY 12524. Telephone: (888) 567-4471. Web: www.careconverge.com.
CareAnyware, ONE WORD CAPITAL "A" IS CORRECT 1903 N. Harrison Ave., Suite 200, Cary, NC 27513. Telephone: (866) 260-4630, Ext 207. Fax: (919) 678-0888. E-mail: firstname.lastname@example.org. Web: careanyware.com.
Consolo Services Group, 2464 Fortune Drive, Suite 150, Lexington, KY 40509. Telephone: (877) 846-5831, Ext. 302. Fax: (866) 539-3170. E-mail: email@example.com. Web: www.consoloservices.com.