CMS is Already Hurting Home Care and Now MedPAC Wants to Make it Worse

The Rowan Report | By Kristin Rowan (Used with permission)

Last week, MedPAC met for their December meeting to discuss "Assessing payment adequacy and updating payments." Hospice services and Home health care services were each presented separately to Congress and commissioners are set to review the key indicators and discuss updates to Medicare payment rates for 2024. 

The findings presented to Congress gave me whiplash.

Hospice Services

• There is 'mixed evidence' on whether hospice reduces Medicare expenditures, but is has important benefits for beneficiaries  
• 2021 saw a 6% increase in hospices, mostly in for-profit agencies
• Hospice use rates are down overall, but MedPAC blames the effects of the pandemic on death rates and patterns of care
• Hospice use continues to shift from SNFs to in-home care
• In 2020, 18.6% of hospices exceeded the payment cap
• MedPAC recommends the cap be wage adjusted and reduced by 20%

See the full Hospice Services presentation to Congress here.

Opinion

Of the 18.6% of hospices that exceeded the payment cap in 2020, 17.2% of those were also in the highest bracket of hospice providers with stays longer thank 180 days. The payment cap is not enough to cover patients who need hospice care for longer time periods, even though the requirement for hospice care is expected death within 6 months. If hospice is intended to care for a patient for 180 days, shouldn't the payment cap be equal to 180 days of care? If a hospice provider is caring for a patient for longer, shouldn't they get paid more? …

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