MedPAC convened for its final meeting of the year December 10-11, 2015 in Washington, DC. The Commissioners reviewed the latest data (2014) related to utilization, access to care, margins, and other information on the home health and hospice benefits.
- Home health supply continued to grow while volume and spending declined slightly in 2014. Most of the decline in volume came from the moratoria on new agencies in five states (Texas, Louisiana, Illinois, Tennessee, and Florida). MedPAC estimates average Medicare margins for 2014 at 10.8 percent and 6.4 percent for non-profit agencies. Performance on quality measures did not change significantly from 2013 to 2014.
- Hospice supply has increased rapidly and is driven by new for-profit entrants. While hospice use continues to grow, the number of users and spending in the program did not increase significantly in 2014. While public access to quality measures is not available, MedPAC reported on live discharge rate and length of stay. Average length of stay did not change significantly; however, there was a decrease in live discharge rate. Despite this decrease, MedPAC reported that there is a subset of hospices with high live discharge rates: 12 percent of hospices have double the national average rate of live discharges. Discrepancies also exist in margin. Whereas MedPAC calculated an overall hospice margin for 2014 of 8.6 percent, non-profit hospices averaged 1.2 percent.
The Commission will issue its draft recommendations in January 2016. Home health agencies can expect to see the same recommendations as in prior years, including: (1) no payment update for 2017, (2) an additional rate rebasing lasting two years and beginning in 2018, and (3) removal of the rate adjustment based on therapy visits. Hospices can expect a recommendation for no payment update for 2017.