Hospice Operators Happy with New CMS Pay for 2010
but Fear Cuts in Health Care Reform
Medicare hospice reimbursement cuts now spread out
over seven years, instead of just 2 years
Aug. 3, 2009 – A long running battle over the
compensation Medicare would pay for hospice care appeared to come to an
end last Thursday with the CMS announcement that payments will increase
by 1.4 percent in 2010. The National Hospice and Palliative Care
Organization said today that this brings some relief to hospice
providers but they still have concerns.
The hospice payment increase is the net result of a
2.1 percent increase in the “hospital market basket,” an indicator of
input price increases, offset by a 0.7 percent decrease in payments to
hospices due to CMS’ revised policy to phase out its wage index budget
neutrality factor, according to the news release from the Centers for
Medicare & Medicaid Services (CMS).
“Specifically,” CMA says, “the final rule revises
the phase-out of the wage index budget neutrality adjustment factor (BNAF)
which was made final in the fiscal year (FY) 2009 final rule, to now
occur over seven years.”
“Medicare hospice reimbursement cuts associated
with the elimination of the Budget Neutrality Adjustment Factor have now
been spread out over seven years, instead of being harshly phased in
over just 2 years,” explains the industry organization.
Under CMS’s final policy, the budget neutrality
adjustment will be reduced by 10 percent in FY 2010, and 15 percent each
year from FY 2011 through FY 2016.
NHPCO, which sees these changes in the BNAF
phase-out partially to the significant advocacy efforts of the hospice
community, still sees “threats.” It sees provisions in some of the
health care reform legislation pointing to possible reductions in the
market basket increase of 2.1% that hospices expect to receive..
For nearly 18 months, the hospice community has
been fighting a regulation originally proposed in the FY2009 Wage Index
issued by the previous Administration, which would reduce hospice
reimbursement by eliminating the budget neutrality adjustment factor (BNAF),
according to NHPCO.
In the FY2010 Wage Index, the current
Administration considered, through their review of the submitted
comments, the severity of the economic conditions facing the hospice
community and the ever-increasing desire by patients and families to
have access to high-quality end-of-life care.
NHPCO says the seven-year phase out of the BNAF
affords the hospice community a more rational approach to absorbing the
eventual rate reductions over a much longer period of time. While the
end result is the same, a substantial and unwarranted rate reduction,
this approach recognizes the ongoing financial pressures facing the
hospice community and prioritizes compassionate and high-quality care
for our nation's most vulnerable population, the dying and their
families.
“Hospice Advocates throughout the nation have been
crucial in getting us to this important point.” said J. Donald
Schumacher, president and CEO of NHPCO.
“Our efforts as a unified hospice community to tell
the hospice story to Congress and the President have been realized. The
voices of the more than 1.4 million patients, and their families, served
by hospice each year have been heard.”
“However, while the impact of the BNAF cuts has
been softened, threats to hospice reimbursement rates have not been
eliminated. We'll keep working with Congress to try to fully eliminate
the cuts, and look for further relief on the proposed “productivity
factor” cuts to help finance health care reform,” Schumacher added.
The rule also adopts a Medicare Payment Advisory
Commission (MedPAC) recommendation which requires physicians to complete
a narrative on the certification and recertification describing the
clinical justification for the patient’s terminal prognosis.
The proposed rule also sought comments on future
hospice payment reform, the cap calculation methodology, and on
requiring physician visits to evaluate eligibility in patients with
longer lengths of stay. CMS will consider the comments in future
analyses.
This final rule reflects the ongoing efforts of CMS
to support beneficiary access to hospice services while maintaining
responsible financial stewardship of the Medicare Trust Fund.
Final Rule Details by CMS
"The BNAF is to be phased-out over seven years,
beginning with a 10 percent reduction in FY 2010, and followed by an
additional 15 percent reduction in each of the next six fiscal years.
Phase out will be complete in FY 2016. This more gradual phase-out
provides opportunity for CMS to consider the effects of a reduction in
payments in the context of hospice payment reform, which is under
consideration. The 10 percent reduction to the BNAF is partially offset
by the annual market basket increase, which is 2.1 percent for fiscal
2010.
"This rule also makes final a change to the
physician certification process, where doctors will be required to
submit a brief narrative supporting a patient’s life expectancy of six
months or less.
"A link to the final rule, which will be published
in the Federal Register on August 6, 2009, along with accompanying
documents will be available at:
NHPCO said it and its affiliate The Alliance for
Care at the End of Life (http://www.afceol.org)
anticipate further advocacy activity when members of Congress return to
their home districts during the August recess.
Aug. 3, 2009 – A long running battle over the
compensation Medicare would pay for hospice care appeared to come to an
end last Thursday with the CMS announcement that payments will increase
by 1.4 percent in 2010. The National Hospice and Palliative Care
Organization said today that this brings some relief to hospice
providers but they still have concerns.