Home Health & Hospice Week

Reforms would revamp payments, accountability, and data collection. Hospice providers may soon have a whole new payment structure -- and it could mean a big drop in reimbursement. Medicare's hospice program offers few effective controls to prevent long lengths of stay or increased costs, Medicare Payment Advisory Com-mission staff contend after an extensive review of the benefit. The Medicare hospice benefit is supposed to provide patients with an alternative to costly and intensive end-of-life curative treatment, but the payment system contains incentives that push hospice providers to seek out patients who will require a longer stay, MedPAC staff maintained at a Nov. 6 meeting. Between 2000 and 2006, the number of patients using Medicare's hospice benefit grew from 513,800 to 942,500 -- an 83 percent jump -- and Medicare spending tripled. Staffers want MedPAC's commissioners to recommend that Congress restructure the hospice reimbursement system to "ensure that the level and structure of payments are sufficient to ensure appropriate hospice care for Medicare beneficiaries who elect this benefit." MedPAC's staffers reported three key areas for reform: payment system, accountability, and data collection. Because long-stay patients have become more profitable, the average length of stay for hospice patients has increased, MedPAC believes. The top 10 percent of patients stayed in hospice for an average of 144 days in 2000, but that number grew to 212 days by 2005. That means hospice providers may be enrolling and recertifying patients who aren't eligible for the benefit or that they are passing over short-stay patients in favor of more lucrative long-stay patients, MedPAC staff accused. New way: MedPAC's staffers proposed that the restructured payment system should reimburse providers along the hospice "cost curve," which would mean reducing reimbursement beginning in the second month of the stay and then at regular intervals through the length of the stay. Because the group found costs to be higher at the beginning and end of the stay, providers would receive an increased payment after the patient's death. The budget-neutral restructure would cut the number of long stays by forcing hospice providers to carefully screen patients, and it would make shorter stays more profitable, staffers predict. Potential drawback: While shorter lengths of stay would appeal to providers more, this change "might result in later starts of care for expected long-stay patients," notes Janet Neigh with the National Association for Home Care & Hospice. For example, a provider might delay a start of care for a hospice patient until enrolling him would be more profitable. Also, providers could screen out long-stay patients who desperately need services. Crucial: Any hospice restructure must "keep together current services' holistic package," Neigh urges. NAHC and other industry associations, including the National Association for Hospice Access and the American [...]