Reimbursement Hike, Other Changes Coming to Hospice

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Rhonda Perrin Oaks, RN, CHP By Rhonda Perrin Oakes, RN, CHPN 
Regulatory Analyst, Change Healthcare
Reimbursement Hike

The Centers for Medicare & Medicaid Services (CMS) released the hospice final rule for FY2018, increasing overall Medicare hospice payments by 1% after adjustments for inflation. The aggregate increase is expected to be $180 million, which follows a 2.1% ($350 million) reimbursement increase for FY2017.

The final rule also notes that Hospice Compare is expected to be operational in August 2017 and provides updates on existing and upcoming quality and reporting measures.

Here’s a look at measures most expected to impact hospice organizations.

Hospice Compare

Initially, only information from the Hospice Item Set (HIS) will be reported on Hospice Compare. Information from Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Survey is expected to follow over the winter. Public reporting of information is expected to help patients and their families make more informed decisions about seeking hospice care while encouraging organizations to monitor and improve care quality. CMS also finalized rules governing the release of aggregate quality data files and Provider Preview Reports, which gives hospices a 30-day preview before publication.

More quality reporting

CMS finalized eight survey-based measures for the CY2018 data collection period and beyond. These questions are believed to be useful to patients and their families, allowing useful comparisons among hospice providers.

Six of the questions are derived from the CAHPS Hospice Survey. Each measure consists of two or more question concerning:

  • Hospice team communication
  • Getting timely care
  • Treating family member with respect
  • Getting emotional and religious support
  • Getting help for symptoms
  • Getting hospice care training

Two global survey-based measures consist of a single question related to:

  • Rating of hospice
  • Willingness to recommend hospice

The final rule codifies a proposed exemption on reporting following an extraordinary circumstance (weather event, systemic data event, etc.), extending the time to request an extension from 30 to 90 days.

For more information about the survey, visit

Update on HEART

Work continues on a next-generation outcomes reporting tool, the Hospice  Evaluation & Assessment Reporting Tool (HEART). HEART is expected to replace the Hospice Item Set at some point, but CMS stressed that development of a new tool remains in the preliminary stages. Plans are to seek industry input at a later time.

The goal for HEART is “to develop a hospice patient assessment tool that is scientifically rigorous and clinically appropriate for the hospice population.” Further, CMS believes the new tool “would provide richer data to offer a broader, more comprehensive picture of quality of care received by hospice patients and their families.”

Potential future measures

The final rule outlined two potential measures that CMS is examining. The first is Potentially Avoidable Hospice Care Transitions. The final rule calls avoidable care transitions “burdensome to patients, families, and the health care system at large, because they are associated with adverse health outcomes, lower patient and family satisfaction, higher health care costs, and fragmentation of care delivery.” The goal would be to improve care quality for hospice patients by reducing transitions.

The second potential measure is Access to Levels of Hospice Care. The goal would be to assess the rates that hospice organizations provide the four levels of care: routine home care (RHC), continuous home care (CHC), general inpatient care (GIP) and inpatient respite care. The belief is that more intensive hospice care may increase the likelihood of patients dying in their location of choice, decreasing healthcare utilization while increasing patient and caregiver satisfaction.

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