NHPCO Comments on CMS Proposed FY2018 Hospice Wage Index Rule

On April 27, 2017, the Federal Register posted the FY2018 Hospice Wage Index proposed rule for public inspection.  Download the proposed rule, public inspection version (PDF). 

Overall, the Notice of Proposed Rule Making is both encouraging and discouraging for providers in the U.S. hospice community. NHPCO is pleased that CMS is recognizing the regulatory and administrative burdens facing the hospice community, and that CMS is trying to find ways to not add to that burden. We applaud the effort and recognition of the challenges of serving our nation’s patients and families.

Market Basket Increase
Unfortunately, the statutory limitation of the FY 2018 market basket to no more than a one percent increase, when the NPRM notes that it should be at least twice as much (2.2 percent) further burdens the community facing ever-increasing costs, and forces hospice providers to do more with less.

Quality Measures and Public Reporting
The hospice community is encouraged that CMS continues its efforts toward developing and implementing quality measures and public reporting, including a Star rating system.  At the same time, the hospice community is concerned about the use of claims data as the basis of new measures.  Also, it appears that CMS is intent on merely documenting the amount of continuous care and general inpatient care that is delivered, rather than assessing the actual needs of patients and how the hospice community is meeting those more intense clinical needs.

Patient Eligibility and the Physician’s Role
While CMS notes it is soliciting comments about the underlying documentation that is used, or should be used to determine patient eligibility, they seem to be ignoring the persistent problem of short hospice stays.

The thrust of their inquiry seems to be directed toward hospice physicians being required to review and reference the attending physician’s medical notes prior to the initial certification of a patient as eligible for hospice, or even requiring a face-to-face encounter with the hospice physician, prior to certification.  The hospice community already deals with patients dying during the admissions process, and with approximately 25 percent of hospice patients dying within seven days, and more than half within two weeks, waiting for patient records, or an appointment with the hospice physician, would be a cruel and inhumane process that would deny patients the very care they need.

Unless and until there is universal electronic medical records and the medical records are accessible across all care settings, this approach is very troubling indicator of a lack of understanding of what patients and families are going through and the devastating impact that it could have on hospice admissions.

CMS did note that the level of live discharges, from all causes, had remained relatively constant at 17 percent and as such, didn’t reveal any anomalies.

SIA Impact
CMS also noted that the Service Intensity Add-on didn’t seem to have influenced the number or duration of visits by clinical specialists in the last seven days of life.  As the hospice community continues to make adjustments under the new payment system, this bears additional review.

We look forward to a very engaged and collaborative working relationship with CMS to provide insights and actual operational impact examples of their proposals.

NHPCO members will find a regulatory alert offering more detailed analysis available on the NHPCO website.