Government

Medicare hospice pay to drop 1.1% in fiscal 2010

Officials also propose that hospice physicians explain why an incoming patient has less than six months to live before the patient is certified or recertified.

By Chris Silva — Posted May 8, 2009

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In an attempt to bring Medicare hospice pay more in line with that of home health agencies, the Centers for Medicare & Medicaid Services has called for phasing out an adjustment to the wage portion of hospice pay starting next fiscal year.

Under an April 21 proposed rule, payments to Medicare-participating hospices are expected to decrease by approximately 1.1% in fiscal 2010 as a result. CMS started enacting a plan to phase out the special payment adjustment in last year's final hospice pay rule, but Congress stepped in to stop the initial reduction earlier this year.

Getting the phase-out back on track for a final elimination in fiscal 2011 would save Medicare nearly $3 billion over five years, CMS estimates. Even with the proposed reductions, Medicare payments to more than 3,000 hospices across the country are expected to be about $13 billion next year.

In addition to bringing hospices more in step with home health agencies when it comes to pay, the proposed regulation should maintain the fiscal integrity of Medicare and allow continued access to services for beneficiaries, CMS said. The Medicare Payment Advisory Commission reported that through 2015, hospice expenditures are projected to grow at a rate that outpaces those projected for hospitals, skilled nursing facilities, physician services and home health care.

The rule also proposes implementing a MedPAC recommendation that would increase accountability in the physician hospice certification and recertification process, CMS said. The commission found an increasing proportion of hospice patients with stays exceeding 180 days as well as significant variation in hospice length of stay. In response to this, the agency has proposed that hospice physicians who certify or recertify a beneficiary as terminally ill be required to write a short narrative on the certification form that briefly describes the clinical evidence supporting a life expectancy of six months or less.

Comments on the proposed rule are due to CMS by June 22.

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