Hospice is entering a new chapter. Among other developments, updated survey guidance, which is forthcoming, promises to create a harsher, more punitive landscape for hospice providers.
The guidance is based on the Hospice Act of 2020, which overhauled the survey process in hospice. Among other changes, the guidance will bring the special focus facility program for poor performers — now at play in nursing homes — to the hospice program. Accompanying that will be the potential for civil monetary penalties and payment suspension for noncompliance.
“Those are big-boy responses to noncompliance, to quality issues, that have never been a part of the hospice program,” said Davis Baird, director of government affairs for hospice at the National Association for Home Care & Hospice, who talked about this during a McKnight’s Newsmakers podcast at NAHC’s recent annual conference. “They’ve been part of other Medicare programs. It’s almost hospice’s turn around the wheel … for some of this stuff.”
Hospice is dealing with other challenges, Baird discussed. As an example, it is not faring particularly well in the Medicare Advantage Value-Based Insurance Design model, which is approaching its third year and testing out hospice as part of the MA model. Early evaluation data find that members are finding it hard to get paid on time or at all, they are facing a significant administrative burden, and some are not being contracted with to deliver an upstream palliative care component, Baird said.
“It’s not to say that these things can’t be addressed … but the early implementation experience has been a challenge,” Baird said.
Representing yet another change for hospices, this year they are being evaluated on two new claims-based metrics. One is the Hospice Care Index, a composite measure made up of 10 quality indicators; the other is Hospice Visits in the Last Days of Life.
There’s no question the government is taking a new, more critical look at hospice. One reason, as Baird explained, is the growth in the benefit as the population has aged. Hospice cost Medicare about $21 billion in 2019. Another is the level of fraud in the program. One glaring example is California’s bumper crop of hospice criminals, which has raised a red flag for regulators in the state and nationally.
“There have been, with the growth in the benefit, small pockets of genuine bad actors out there who have gotten into the game for all the wrong reasons, to juice the system, line their pockets,” Baird said.
And, now, it seems, the entire field, through the updated survey guidance and other actions, is paying the price.
Liza Berger is editor of McKnight’s Home Care. Email her at [email protected].