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Healthcare reform is affecting change throughout the South Florida community. The Hospice arena is no exception. There have been changes in hospice utilization since the inception of the Medicare Hospice benefit back in 1983. We are seeing increased usage as the baby boomers are accessing the benefit. It is understandable that healthcare reform needs to include hospice.Before the Affordable Care Act was implemented, Hospice was already being financially impacted by the Budget Neutrality Adjustments, starting in 2009. These adjustments ultimately resulted in a decrease of 4.2% in rates during its 7 year implementation. Sequestration takes another 2% of reimbursement which is another example of the ongoing cuts to hospice. How does this decreased reimbursement affect hospice? Let’s consider the costs that continue to increase for services provided: therapies, pharmacy, transportation, medical supplies and durable medical equipment, just to name a few. Employees who deserve to be paid fairly and whose wages should reflect fair market rates must be considered. Another is the implementation of the face to face visit requirement for every hospice patient entering their third benefit period and each benefit period thereafter, at the expense of the hospice. Provider costs continue to increase for services with reimbursements declining, hospices face the difficult reality that continuing to provide quality service and care while maintaining financial solvency will call for new strategies and courageous voices on behalf of those who depend on our services.
One of the positive outcomes of healthcare reform is the focus on quality. Through the implementation of the new Hospice CAHPS and the Hospice Item Set data indicators there will now be a standard way to measure hospice quality across the nation. All responses for admissions and discharges must be submitted to CMS within five days. Reporting this data is costly in labor and impacts the care to patients as resources may be allocated to administration rather than to clinical bedside needs of patients at end of life.
Additional reporting requirements are not limited to quality indicators. The Affordable Care Act requires hospices to collect and report data and information. Examples of this information include number of days and visits of each type of service, length of each visit, and all medications prescribed. Challenges with collecting, entering and submitting the data can impact the timeliness of monthly billing. The hospice cost report has also been expanded to include costs by discipline, by level of care. Data submitted will be used to determine future revisions of hospice care payments.
The beginning of 2016 brings the implementation of more changes to hospice payment rates. The new rule differentiates payments for routine home care based on the beneficiary’s length of stay and implements a service intensity add-on (SIA) payment for certain services provided in the last 7 days of life. How will this change impact hospice? Based on the past trends of the healthcare reform I do not believe that we will see additional revenue to support our industry. The Medicare Care Choices Model (MCCM) demonstration project also will roll out in 2016. This Concurrent care demonstration project will allow eligible participants to continue receiving curative care while receiving hospice care under a flat monthly payment. The 5 year project may impact the future of hospice as we know it.
I am hopeful that when we look back on all of the changes to hospice within healthcare reform we will be able to see that they were for the benefit of those we serve and that we will be able to stand with compassion and hope next to those persons experiencing challenges at the end of their lives.
