MedPAC Releases 2013 Report to Congress on Hospice Payment
Monday, March 25, 2013
by: VNAA Policy Team

Section: Public Policy and Advocacy

March 15, the Medicare Payment Advisory Commission (MedPAC) released their yearly recommendations to Congress on changes to Medicare payment. While the number of Medicare beneficiaries using hospice continues to grow, the average length of stay was steady overall in 2011 after considerable growth since 2000. The projected 2013 margin for hospice providers is 6.3 percent.
MedPAC Hospice Recommendations:
  • The Congress should eliminate the update to the hospice payment rates for fiscal year 2014.
  • The Congress should direct the Secretary to change the Medicare payment system for hospice to:
    • have relatively higher payments per day at the beginning of the episode and relatively lower payments per day as the length of the episode increases,
    • include a relatively higher payment for the costs associated with patient death at the end of the episode, and
    • implement the payment system changes in 2013, with a brief transitional period.
  • These payment system changes should be implemented in a budget neutral manner in the first year. (First recommended in March 2009).
  • The Congress should direct the Secretary to:
    • require that a hospice physician or advanced practice nurse visit the patient to determine continued eligibility prior to the 180th-day recertification and each subsequent recertification and attest that such visits took place,
    • require that certifications and re-certifications include a brief narrative describing the clinical basis for the patient’s prognosis, and
    • require that all stays in excess of 180 days be medically reviewed for hospices for which stays exceeding 180 days make up 40 percent or more of their total cases. (First recommended in March 2009).
VNAA members and staff met with MedPAC in February to discuss the VNAA and VNSNY Vulnerable Patient Study, home health rebasing in 2014 and hospice payment issues. The primary focus of this meeting was to assist MedPAC in better understanding the needs of vulnerable patients and the nonprofit agencies that serve them. 
To read the full report on hospice payment, please click here.
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