On Friday, March 15, 2019, MedPAC released its March 2019 Report to the Congress. The Hospice Chapter contains an analysis of the current state of hospice – beneficiary access to care, quality of care, Medicare spending and margins and a recommendation for 2020. Access the complete report on the MedPAC website.
A summer of key points from the chapter on hospice include:
Utilization of hospice by Medicare beneficiaries:
- 2000: 22.9% of Medicare beneficiaries enrolled in hospice
- 2017: 50.4% of Medicare beneficiaries enrolled in hospice
Diagnosis mix
- 2000: 48% had non-cancer diagnoses
- 2017: 74% had non-cancer diagnoses
Number of hospices
- 2017: 4,448 Medicare-certified hospices
- Growth: 5% per year, 100% of growth among for-profit hospices
- State growth: Concentrated in California and Texas.
Medicare spending in 2017:
- $17.9 billion
- $10.1 billion for stays greater than 180 days
Above cap hospices:
Approximately 12.7% of hospices exceeded the aggregate payment cap in 2016. According to MedPAC, “The average amount by which above-cap hospices exceed the aggregate cap has been decreasing over time.” MedPAC notes that there are characteristics that above cap hospices have in common:
- Substantially longer lengths of stay
- Higher rates of live discharge compared to other hospices
MedPAC expressed concern that above-cap hospices “are admitting patients who do not meet the hospice eligibility criteria, which merits further investigation by the Office of Inspector General and CMS.”
Visits in the Last Days of Life:
The Commission expressed concern that the RN and social worker visits in the last days of life, known as Service Intensity Add-on, are only increasing modestly, although the time of the visits has declined.
Hospice Quality Reporting:
The Commission reports that the vast majority of quality measures are “topped out”. CAHPS measures provide more indication of performance and identify areas for improvement. More work is needed to identify outcome measures in addition to the current process measures.
Hospice Margins:
The Commission reports margins of 10.9%, the highest margins in more than 10 years. They project an estimated margin of 10.1% for 2019.
MedPAC Recommendation for 2020:
- Hospice services – For 2020, the Congress should reduce the fiscal year 2019 Medicare base payment rates for hospice providers by 2 percent.
In a statement about the March Report, National Hospice and Palliative Care Organization President and CEO Edo Banach, said, “NHPCO recognizes and supports the need for all hospice programs to perform their roles utilizing the highest standards of care and an enduring commitment to high-quality compassionate care for people they serve. Given the complexity of care provision to the dying, extra care should be undertaken to ensure that any suggested changes to the Medicare Hospice Benefit must be measured and exclusively informed by validated data.”
“The hospice community stands ready to work with MedPAC and any responsible policy making body to improve the delivery and experience of end-of-life care in this country,” added Banach.
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