For more than a year, the hospice community was on the edge of our collective seat, watching the political process that has consumed health care reform. To say that this journey has been a winding road is an understatement, but with each curve Hospice Advocates have been very clear and unified in our messaging to Congress.  During this process, we have been unified in our messaging against cuts to hospice and for provisions to enhance and expand access to high-quality, compassionate end-of-life care.

In late March, Congress passed H.R. 3590 (the Patient Protection and Affordable Care Act) which the President subsequently signed into law. Here’s a brief overview of the included provisions impacting end-of-life care:

Market Basket Cuts & Productivity - Incorporates a productivity adjustment reduction into the market basket update beginning in fiscal year 2013, as well as a market basket reduction of .3 percent for hospice providers from fiscal years 2013-2019.  Note that these cuts will not take effect until FY 2013.

Hospice Payment Reforms – (1) This provision would require the Secretary to collect data and update Medicare hospice claims forms and cost reports by 2011.  (2)  Based on this information, the Secretary would be required “implement revisions to the methodology for determining the payment rates for routine home care and other services included in hospice care” no earlier than FY 2013.  (3)  After January 1, 2011, a hospice physician or nurse practitioner must have a face-to-face encounter with each hospice patient to determine continued eligibility for hospice care prior to the 180th-day recertification and each subsequent recertification, and attest that such visit took place.  In addition, the Secretary will medically review certain patients in hospices with high percentages of long-stay patients.

Medicare Hospice Concurrent Care Demonstration Program -  Directs the HHS Secretary to establish a three-year demonstration program that would allow patients who are eligible for hospice care to also receive all other Medicare covered services while receiving hospice care. The demonstration would be conducted in up to 15 hospice programs in both rural and urban areas and would undergo an independent evaluation of its impact on patient care, quality of life and spending in the Medicare program.

Curative and Palliative Care for Children in Medicaid and CHIP - Allows children who are enrolled in either Medicaid or CHIP to receive hospice services without foregoing curative treatment related to a terminal illness.

Independent Payment Advisory Board - Creates an independent Payment Advisory Board tasked with presenting Congress with comprehensive proposals to reduce excess cost growth and improve quality of care for Medicare beneficiaries as well as the private health system. When Medicare costs are projected to be unsustainable, the Board’s proposals will take effect unless Congress passes an alternative measure that achieves the same level of savings. Congress would be allowed to consider an alternative provision on a fast-track basis. Requires the Board to make non-binding Medicare recommendations to Congress in years in which Medicare growth is below the targeted growth rate.  Beginning in 2020, requires the Board to make binding biennial recommendations to Congress if the growth in overall health spending exceeds growth in Medicare spending.

Hospice Value Based Purchasing/Promoting High Value Health Care - Provides the Secretary of HHS the authority to test value-based purchasing programs for long-term care providers, including hospice providers, no later than January 1, 2016.

Quality Reporting - Requires hospice to report on quality measures determined by the Secretary (endorsed by the new quality measure consensus-based entity) or face a 2 percent reduction in their market basket update.  Measures published in 2012 for reporting to begin in 2014.

Nationwide Program for National and State Background Checks on Direct Patient Access Employees of Long-term care Facilities and Providers - Establishes a national program for long- term care facilities and providers to conduct screening and criminal and other background checks on prospective direct access patient employees.

Advancing Research and Treatment for Pain Care Management - Authorizes an Institute of Medicine Conference on Pain Care to evaluate the adequacy of pain assessment, treatment, and management; identify and address barriers to appropriate pain care; increase awareness; and report to Congress on findings and recommendations. Also authorizes the Pain Consortium at the National Institutes of Health to enhance and coordinate clinical research on pain causes and treatments. Establishes a grant program to improve health professionals’ ability to assess and appropriately treat pain.

Education and training programs in pain care - Secretary may make grants available to hospices and others to develop and implement pain care education and training programs for health care professionals. 
 

We're Still Fighting

While we appreciate the fact Congress continues to embrace hospice as a vital part of health care at the end of life and we’re pleased to see the provisions included expanding access to hospice, we simply can’t afford to lose $6.8 billion from the national investment in end-of-life care. 

We have said it all along; two cuts are too much for hospice.  And we mean it.  The productivity cuts on top of the more than 4 percent regulatory reduction associated with the elimination of the budget neutrality adjustment factor (BNAF) we began absorbing in 2009 and will continue to absorm over the next five years, is more than the community can or should sustain.  NHPCO will continue to ensure that hospice is “at the table” after the political dust settles and before the community and the patients we serve feel the brunt of the cuts.