Hospices Seek Clarity on Value-Based Risk

Hospice News | By Holly Vossel

When it comes to putting value-based payment arrangements in action, regulators and payers have gaps to fill in around billing and quality measurement. Some community-based hospice providers in particular have reported “tremendous confusion” regarding risk-bearing models as they look ahead to new and growing payment model demonstrations.

The first steps came with the hospice components of the value-based insurance design (VBID) demonstration, known as the Medicare Advantage (MA) hospice carve-in, which is nearing the start of its second year. Additional models taking shape include the direct contracting program and Primary Care First, among others, as well as forthcoming, yet-to-be announced demonstrations from the Center for Medicare & Medicaid Innovation (CMMI).

Hospices have been preparing for a shift to more risk- or performance-based models by honing their approaches to payer partnerships, diversifying their services and implementing new processes and technology into their workflows.

Thus far, there’s a “tremendous amount of confusion, misunderstanding and just general unclearness” in the potential financial risks within value-based care models and where hospices, particularly of where community-based providers, fit into the mold, Sara Dado, senior director of clinical programs at Lightways Hospice & Serious Illness Care, told Hospice News.

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