Mastodon Medicare proposing a 1.3% ($200M) rate for hospices for FY 2016 ~ Pallimed

Friday, May 1, 2015

Medicare proposing a 1.3% ($200M) rate for hospices for FY 2016

First reported by Modern Healthcare, CMS (Medicare) has proposed a 1.3% rate increase for hospice organizations for FY 2016, which is a just under the 1.4% increase for FY 2015. This comes from a un-published proposed rule that also has some other provisions including clarification on diagnosis reporting, and a review of data that may inform hospice payment reform based on increased service intensity in the last seven days of a beneficiary's life. The official release date is May 5th, with a 60 day comment period to follow.

There are some really insightful charts and graphs in this report to look at diagnosis, cost and use patterns.  For example, this one on Medicare daily costs in the 180 days prior to hospice admissions vs the length of stay on hospice. Many in the field recognize that people recently on hemodialysis may get hospice very late, and that people with dementia are on hospice longer.  But from a systems standpoint, I never thought about how CMS may see these pre/post-hospice costs. I drew an extra red line on the graph to approximate the daily hospice reimbursement rate of $153 (FY 2013). So looking briefly at this graph, one may make an argument that hospice care may be (slightly) more expensive than traditional medical care at the end of life. Important to understand if this is how CMS and policy makers are looking at it.

We welcome discussion here about what you see as good and bad about this proposed rule and hope to have further analysis of the document as we get time to review it (volunteers needed). In addition, we hope that you fulfill your role as hospice and palliative care advocates and submit a comment* to CMS on this proposed rule; even if it is as simple as "Continue support for the Medicare Hospice Benefit!" But we know you are more creative and passionate and will come up with something much more substantial!

*comments are not yet open since the rule is not officially published. But no worries, we will remind you when it is time along with highlighting a few of the areas you may be most interested in.

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