Tuesday, March 21, 2017

MedPAC Releases March Report to Congress

The Medicare Payment Advisory Commission released its annual  March report to Congress on Wednesday, March 15, 2017.

The hospice chapter begins with an updated snapshot of the hospice industry. According to MedPAC, 1.38 million Medicare beneficiaries (or almost 49% of Medicare decedents) received hospice care in 2015 from 4,200 hospice providers. In that year, Medicare spent $15.9 billion on hospice care, up from $15.1 billion in 2014. However, Medicare spending on hospice care constituted less than 3% of overall Medicare spending.

In the report, the Commission recommends that “Congress should eliminate the update to the hospice payment rates for fiscal year 2018,” which is consistent with previous MedPAC recommendations.

It is important to remember that Congress must take action for a MedPAC recommendation to be implemented, which it has not done in recent years.

Learn more about the hospice chapter from the  Hospice Action Network blog.

Listen to NHPCO's Podcast, Episode #12 to here more about the report's focus on live discharge.

Tuesday, March 14, 2017

SMRC Audit on GIP Claims

The Centers for Medicare and Medicaid Services has contracted with StrategicHealthSolutions, LLC as a Supplemental Medical Review Contractor (SMRC) for a review of patient GIP stays. (NHPCO members will find a Regulatory Alert offering further information on this GIP claims audit.)

Many hospice providers have asked for clarification about the role of the Supplemental Medical Review Contractor. What follows is some basic information about SMRC.

As the Supplemental Medical Review Contractor (SMRC), StrategicHealthSolutions, LLC has been contracted by CMS Center for Program Integrity to perform and/or provide support for a variety of tasks aimed at lowering the improper payment rates and increasing efficiencies of the medical review functions of the Medicare and Medicaid programs. One of their primary tasks will be conducting nationwide medical review as directed by CMS. The medical review will be performed on Part A, Part B, and DME providers and suppliers to determine whether Medicare claims were billed in compliance with coverage, coding, payment and billing practices. 

The selection of topics and time frames to be reviewed is determined by and at the direction of CMS. The focus of the projects may include, but are not limited to issues identified by Federal agencies, such as the Office of Inspector General (OIG), Government Accountability Office (GAO), CMS internal data analysis, the Comprehensive Error Rate Testing (CERT) program, professional organizations and First-Look Analysis Tool for Hospital Outlier Monitoring (FATHOM) report and Program for Evaluating Payment Patterns Electronic Report (PEPPER). The SMRC is conducting medical review based on the analysis of national claims data versus data that is limited to a specific jurisdiction as performed by Medicare Administrative Contractors (MACs). Unlike the MACs, the SMRC does not perform claim payment functions.

Tuesday, March 7, 2017

Message from Edo Banach

I’ve completed my first official week as President and CEO at NHPCO.  I am honored to lead the organization at this important time of change, and look forward to working together. 

Over the next several weeks and months, I will be learning more about your needs and the ways we can best serve you in the important work you do in your communities every single day.  I look forward to telling your stories to consumers, caregivers and policy-makers and expanding awareness of your dedication and skill. Together, we will build on the strong foundation of hospice and palliative care to grow innovative and compassionate care programs that will serve all in need. 

As I begin my tenure working with you and for you at NHPCO, National Hospice Foundation, and the Hospice Action Network, it seems fitting to reflect on the guiding values of this organization:
  • Service… engaging with you, our members and constituents, is at the heart of all that we do.
  • Respect and Collaboration… valuing the expertise, skills and contributions from the field and fostering partnerships and relationships with all our stakeholders is vital to future success.  
  • Excellence… exceeding the expectations of our members and embracing change and innovation will allow us to continually improve and grow in a manner that will allow us to embrace opportunities.  
  • Stewardship… managing resources with the highest ethical and fiscal standards will ensure accountability of your investment within NHPCO and foster integrity throughout our organization.
Please know that I take these values seriously and they will serve me and the entire team as we work together towards the bright future I see ahead of us all. A future that will not be without challenges, certainly, but I know that we can meet these challenges together as we strive to provide the highest quality care for those in need of our services and care.

I’ve been fortunate to meet a number of NHPCO members during my first week and I know this will continue.  I look forward to meeting you at our upcoming Management and Leadership Conference on May 1 – 3, 2017 at the Washington Hilton. If you have not already registered, I hope you’ll consider joining us. This will be a great opportunity to get to know each other better.

I look forward to our work together.

Edo Banach, JD
President and CEO


Tuesday, February 28, 2017

“Culture” + “Curiosity” = Culturosity®

A Desire to Learn about and Interact with Different Cultures

There are populations who do not benefit from equitable access to quality end‐of‐life care because of a history of healthcare disparities. Culturosity: Competence inTransitioning End‐of‐Life Care for Underserved Populations from Disparity toEquity is a special preconference seminar addressing this topic that is being offered on Sunday, April 30, 2017, the day before the 2017 Management and Leadership Conference officially begins. 

This daylong workshop will provide participants the opportunity to work through the cultural and systemic issues, and the inherent biases that exist for underserved and LGBT communities and communities of color. Using small group sessions, role play and other cutting‐edge interactive techniques, participants will acquire the knowledge and skills to help themselves and their programs develop care that brings equity out of disparity.

A look at NHPCO’s current edition of “Facts and Figures: Hospice Care in America” provides a snapshot of patient race and ethnicity of hospice patients for 2014. While the African American population accounts for over 12% of the overall U.S. population, only 7.6% of those entering hospice programs across the country were African American – and it should be noted that this percentage has dropped in recent years. Those of Hispanic or Latino origin account for 7% of hospice patients and Asians or other Pacific Islanders account for 3%  (this represents a slight increase in reaching these populations); multiracial individuals account for 13%. 

The provider community has made strides to increase under-utilization of hospice and palliative care by minority communities but much remains to be done as the minority populations in the U.S. are projected to increase in the years ahead. 

This seminar, Culturosity, will help providers understand many of the issues involved in disparities and access. Online registration for the Management and Leadership Conference and the preconference seminars is open through March 27, 2017. Register today!


Friday, February 17, 2017

Call for Sessions Proposals Open for Interdisciplinary Conference

Become part of the esteemed faculty for NHPCO’s Interdisciplinary Conference, Strengthen Your Organization: Care, Compliance, Quality, to be held from September 18 – 20, 2017 at the San Diego Marriott Marquis and Marina, San Diego, California. 

The Call for Presentation Proposals is open and proposals are being sought for intermediate to advanced learning level sessions in one of six key areas:
  • Interdisciplinary Leadership: Developing, leading teams and ensuring their optimal functioning 
  • Medical Care: Emergent clinical topics to attract physicians and nurses
  • Supportive Care: Emergent topics in psychosocial, spiritual and bereavement care
  • Regulatory: Latest news on compliance implementation provided by selected faculty
  • Quality: Emergent topics provided by selected faculty
  • Community-based Palliative Care: Featuring model programs/practices and practical “how to" topics
The Call for Proposals is open through Sunday, March 12, 2017; don’t delay. Hospice and palliative care professionals with ideas for a session falling into the six key areas are encouraged to submit a proposal.

Tuesday, February 14, 2017

Application Cycle for HMDCB Exam Now Open

The application cycle for the 2017 Hospice Medical Director Certification Board (HMDCB) exam is now open through March 21, 2017. Nearly 650 individuals from across the country have already been certified in the organization’s first three exam cycles.

So why is physician certification important? According to Suzanne Karefa-Johnson, MD HMDC, a Physician at Hospice of the Comforter in Altamonte Springs, FL, "The HMDCB certification program is an important avenue to establishing one's expertise in the administrative and clinical skillset demanded of a hospice medical director. It helps to affirm the importance of physicians providing end-of-life care within the larger palliative and medical continuum of care."

In addition, initial physician certification and the continuing education required to maintain certification contribute to the creation of an environment of professionalism and a culture of retention — a critical issue for hospices today. Certification is also a vehicle for hospices to differentiate themselves from competitors and demonstrate to consumers that they have attracted the most skilled and experienced healthcare professionals.

By visiting HMDCB’s Physician and CEO pages on its website, you can learn more about the benefits of applying and watch two videos featuring hospice colleagues who share why the certification is valuable. 

The early bird application deadline for the Hospice Medical Director Certification Board’s 2017 exam is Tuesday, February 28. Applicants who complete their application before the deadline save $250! 

Tuesday, February 7, 2017

Medicare Advantage and Hospice

Guest Blog
by Jay Cushman, HealthPivots

The State Hospice Profile™, available from NHPCO, summarizes the use of hospice services by Medicare beneficiaries since 2000.  This chart of the Hospice Penetration Rate, from the National Profile page, shows that enrollees in Medicare HMO plans use hospice at a much higher rate than average.

In 2015, the Penetration Rate for Medicare HMO enrollees was 82% compared to 68% for all Medicare beneficiaries.  In the State Hospice Profile™, Penetration Rate is defined as the ratio of Medicare Hospice Patients Served to Total Medicare Deaths.  The source for these data is the Medicare claims standard analytic files that contain information on beneficiary demographics, deaths, and hospice use. 

Medicare began paying for services for enrollees in 1966, and hospice services were included in the Medicare benefit package in 1983.  In 1997, private insurance plans were included in the Medicare program.   These plans are now collectively called Medicare Advantage as distinguished from Original Medicare which is also called Fee-for-Service (FFS) Medicare.   Medicare Advantage plans are also sometimes called Medicare HMO plans.  Medicare Advantage plans must cover all the services that Original Medicare covers, except hospice care.  If a Medicare Advantage enrollee elects hospice, payments for both hospice and other services are made by Original Medicare.  

However, in 2014, the Medicare Payment Advisory Commission (MedPAC) recommended that Congress should include the Medicare hospice benefit in the Medicare Advantage benefits package.

This change, if implemented, would affect a significant and growing portion of the Medicare enrollees who now choose hospice care.

Since 2004, practically all the growth in Medicare beneficiaries and Medicare deaths has been captured by the growth in Medicare Advantage plans.

Another measure of hospice use is the Death Service Ratio, defined as the ratio between Medicare Hospice Deaths and Total Medicare Deaths. This ratio for Medicare Advantage has significantly exceeded the ratio for Original Medicare.

 This gap is all the more remarkable because Medicare Advantage enrollees are, on average, younger than Original Medicare enrollees.  The use of hospice tends to increase with age even among Medicare beneficiaries.  

Nationally, about one-third of all Medicare beneficiaries were enrolled in Medicare Advantage plans in 2015.  This is more than double the percentage in 2004.

However, in some states the Medicare Advantage enrollment is much higher than average.  In Minnesota, for example, over half of all beneficiaries are enrolled in Medicare Advantage.

These are the facts.  The implication is that any disruption in a hospice’s relationship with its Medicare Advantage patients will have a significant impact on that hospice’s business.

© Health Planning & Development, LLC 2017

The State Hospice Profilefor each state is available for purchase from NHPCO's Marketplace.

Disclaimer: Any views or opinions represented by guest authors on the NHPCO blog belong solely to the author and do not necessarily represent the views or opinions of NHPCO.