While the newly proposed fiscal year 2023 hospice rule is not particularly unusual, there are other key hospice developments in the making. That is according two hospice experts from the National Association for Home Care & Hospice, who spoke at a webinar Wednesday.
The 2.7% Medicare payment bump disclosed earlier last month was “pretty routine,” noted Theresa Forster, vice president for hospice policy and programs for NAHC. She pointed out that it is composed of a 3.1% market basket increase, less a 0.4 percentage point Affordable Care Act productivity adjustment.
Regarding the hospice wage index, for FY 2023, the Centers for Medicare and Medicaid Services has proposed applying a permanent 5% cap to all wage index decreases. The result would be that no hospice provider’s wage index would be less than 95% of its value in the previous fiscal year, Forster said.
CMS’ goal is to address wage index changes with significant negative impact and support greater predictability relative to payments, she noted.
Focus on health equity
One of the more unique aspects of the proposed rule is CMS’ Health Equity Request for Information (RFI), explained Katie Wehri, director of home health and hospice regulatory affairs for NAHC. The purpose of the RFI is to support providers in quality improvement activities to reduce health inequities, enable beneficiaries to make more informed decisions, and promote provider accountability for healthcare disparities. CMS solicited comments from hospice providers on four questions related to health equity.
CMS is broaching health equity in other proposed healthcare rules, indicating that it likely will incorporate health equity measures in quality reporting programs. Providers should take a closer look at the RFI, she said.
“This is something CMS is threading throughout all its programs,” Wehri said.
Also, as part of the hospice proposed rule, CMS said it would initiate a Special Focus Program Technical Expert Panel before November in advance of proposing a Special Focus Program in next year’s rule.
NAHC is “very very pleased that CMS took that on,” Wehri said.
Length of stay concerns
Beyond the proposed Medicare payment rule for hospice, providers should be aware that more scrutiny may be coming due to long length of stay and high live discharge rates, Forster said. The Medicare Payment Advisory Commission (MedPAC) has raised a red flag regarding length of stay for hospice patients, which has increased substantially prior to the year of death — to 335 days for decedents in 2020 from 321 days for decedents in 2019, Forster pointed out. Factors leading to the long length of stay could include uncertainty in establishing a six-month prognosis, financial incentives in the payment system, how referrals are generated and variability in interpretations of hospice eligibility criteria.
The live discharge rate has caused similar concern. Some 10% of hospices have live discharges of 43%+, Forster cited.
MedPAC’s potential remedies include investigating and auditing providers with long lengths of stays and high discharge rates, Forster said.
