Close-up on a doctor holding the hand of a sick woman in bed at the hospital - healthcare and medicine and hospice

The proposed 2.8% hospice payment update for fiscal year 2024 fails to keep up with rising costs, providers told the Centers for Medicare & Medicaid Services.

“The FY 2024 proposed market basket adjustment of 2.8% does not take into account the inflationary pressures hospices are facing, the continued challenge with the cost of staffing in a highly competitive market, or the extreme financial pressures on hospices today,” the National Hospice and Palliative Care Organization said in a letter to CMS Tuesday regarding the proposed hospice rule.

To help correct the low market basket increases in recent years, NHPCO is requesting a “one-time retroactive adjustment” of 3.7% for FY 2021 and FY 2022 “to ensure Medicare payments more accurately reflect the cost of providing hospice care.”

If CMS cannot reconsider the FY 2024 Hospice Wage Index rule, NHPCO would like the special adjustment to be part of the upcoming calendar year 2024 home health proposed rule, the organization said.

NAHC requests adjustment

The National Association for Home Care & Hospice also is asking CMS to enact a retroactive adjustment for hospices for the previous two fiscal years and apply the adjustment to FY 2024 payments.

“NAHC is concerned that hospice payment rates have not kept up with increasing costs that hospices have sustained over recent years related to increased labor costs, higher costs for drugs and supplies, costs of the COVID-19 Public Health Emergency, and intensified regulatory scrutiny,” NAHC said in guidance to members regarding comments to the proposed rule. “Rapid inflation, higher interest rates and financial uncertainties have further impacted hospice financial stability.”

LeadingAge, which provided comments on the proposed hospice rule,  did not ask for a retroactive payment. Still, the organization representing nonprofit providers criticized the 2.8% proposed update, arguing the update fails to cover the needs of hospice providers, particularly with COVID-19 expenses.

“Many of our members’ margins were already thin so increased payment this year and into the future will continue to be essential,” the organization said.

Physician certification question

Tuesday was the deadline for hospice providers to submit comments to the proposed rule, which touched on everything from nonhospice spending and telehealth to ownership transparency. Organizations differed in their opinions of the CMS proposal that physicians who certify hospice services for Medicare beneficiaries be enrolled in or validly opted-out of Medicare as a prerequisite for hospice payment.

While NHPCO supports the measure as a program integrity issue, NAHC said physicians should be excluded from this requirement. It is the patient’s right to designate an attending physician, NAHC said.

“This right may be compromised if the designated attending physician is not enrolled/validly opted out,” NAHC said. “Patients should not have to sever their relationship with the physician who has been most involved in their care in order to elect hospice care.”

Verifying that  the attending physician is enrolled or validly opted out of the Provider Enrollment, Chain, and Ownership System (PECOS) process also could lead to delays in addressing pain and symptoms, NAHC said.

LeadingAge also expressed reservations about the measure.

“We do question what impact this may have on access to the hospice benefit if physicians find this enrollment process, or the process to opt out, which is not clearly defined in this rule, too burdensome,” LeadingAge said.