NAHC/HAA Host Free Teleconference on CMS’ Proposed Regulation for FY2015 Hospice Payment and Policy Changes
May 14, 2014 04:56 PM
The National Association for Home Care & Hospice (NAHC) and its affiliated Hospice Association of America (HAA) recently held a teleconference on the subject of CMS’ proposed regulation for FY2015 hospice payment and policy changes. NAHC President Val J. Halamandaris led the teleconference, and was joined by Bill Dombi, NAHC’s Vice President for Law; Theresa Forster, NAHC’s Vice President for Hospice Programs, and; Katie Werhi, NAHC’s Hospice Operations and Regulatory Expert.
The call was offered to NAHC and HAA members free of charge, and covered a range of topics surrounding CMS’ proposed FY2015 regulations for hospices.
NAHC’s President Val J. Halamandaris started the call by asking the panel of experts what their initial reaction to the proposed rule was.
“This [regulation] was a bit of a surprise,” said NAHC Vice President for Law Bill Dombi. “CMS is very cautious about making changes to hospice…they are taking a deliberative path and they’re very serious about bringing oversight into hospice. [The proposed regulation] is driven by statistics and abnormalities and have highlighted all their areas of concern.”
“What’s interesting is what CMS did not do as part of this regulation. The organization did not put forth any payment reform changes and the regulatory changes that they are proposing are somewhat limited in scope,” said Theresa Forster, NAHC’s Vice President for Hospice Programs. “What is really significant is some of the tone that is used… They are concerned enough [by their research findings related to payment reform that their focus has shifted to] what they can do to beef up program integrity measures and hold off on payment reform until a later date.”
“My first reaction was the tone of the comments and the possible redefinition of the hospice benefit,” said NAHC’s Hospice Operations and Regulatory Expert Katie Wehri. “I was a little surprised that there wasn’t payment reform information but pleased that there is a deliberate approach to gather more data to make the right determination, but really concerned about the tone and approach and what it means to the difference between how hospices have been operating for the last 30 years and what it means for the future.”
“Looking at the regulations, what it said to me is our friends at CMS have a “get tough” approach to hospice, and they’re going to do everything they can to tighten things up before they take the leap of reforming the hospice payment system,” said NAHC President Val J. Halamandaris before asking Ms. Forster to detail some of the specifics of the proposed regulation.
For more on the specific proposals contained in the proposed regulation, please see NAHC Report, May 5, 2014.
When Mr. Halamandaris asked Katie Wehri what the single biggest issue in the proposed regulations is, her response was, “the implications that hospices are potentially not covering care and services that CMS believes should be part of the hospice benefit…There’s a strong signal that CMS is in the process of revising what hospice is considered to be by most of us in the field. It’s pretty ironic that they didn’t propose a rule change, but they do appear to have a change in interpretation.”
The conversation then moved to CMS’ allegations that some hospices were abusing the system by engaging in “reverse bundling” - under which hospices are shifting payment responsibility for some services to other parts of the Medicare program.
Mr. Halamandaris asked what the prospects for a legal challenge were. Mr. Dombi suggested that the hospice field would need to wait and see how the changes were manifested and how CMS chooses to apply the proposed regulations.
“There’s no [foundation] for litigation right off the bat, but it is something that we will be watching very, very carefully,” explained Mr. Dombi. “If you wanted to predict what you’ll see out of this rule: a Medicare contractor reads it, and they’re going to deny a lot of claims retroactively. They’re going to say that all services are paid for by the hospice and none will be paid for by Part A, Part B or Part D Medicare, and that’s when we’re going to see some legal challenges.”
Despite the lack of payment reforms contained in the proposed regulation, Ms. Forster explained that CMS did include a 1.3 percent increase in payment. That payment increase, however, fails to take into account the 2 percent cut that was mandated by the sequester, and as a result hospices will have to, “try to do more with less.”
When the conversation returned to when structural changes to the hospice payment model may occur, Mr. Dombi suggested that, “we’re looking at a minimum of two and possibility of three or more years before any significant structural payment reforms will be made to the hospice benefit.”
“On payment reform, we haven’t moved forward. We’ve moved to the side,” added Ms. Forster.
“If we’re waiting two, three, four years before we have some payment reform, one of the concerns becomes how to care for the short stay patient. These patients’ care is very costly to the hospice, and I hope that the deliberate approach taken by CMS on payment reform does not discourage hospices from caring for those kinds of patients, though hospices with a high proportion of short stay patients will be in trouble financially,” said NAHC’s Vice President for Law Bill Dombi.
Short stay patients are a real and growing concern for hospices. Theresa Forster cited Congressional Budget Office data indicating short stay patients made up 5 percent of the hospice population in 2000, and had increased to 10 percent by 2009. “This is becoming a greater concern for hospices.”
Katie Wehri was asked to explain what “unbundling” means within the proposed regulation. “It is looking at charges for care to hospice patients outside of the Medicare hospice benefit. Among other things, CMS is looking at patterns of when a beneficiary has elected the hospice benefit, revokes the benefit and, in the interim, care is charged to other parts of Medicare and then the patient reelects hospice care. CMS is looking at charges the hospice should be incurring that are being picked up by another part of Medicare.”
“Discussions I am hearing about unbundling is that CMS is going to presume that all services are the hospice’s responsibility – a shift of potentially more than a billion dollars from Parts A, B and D to hospices. That’s almost 7 percent of the current hospice benefit [which is equivalent to the average hospice financial margin], and it could put a lot of hospices under water,” added Mr. Dombi.
As the conversation moved to ways hospices can prepare for looming changes and how to weather CMS’ proposed regulations, the panel offered positive parting thoughts on how hospice is evolving.
NAHC President Val J. Halamandaris encouraged everyone to keep in mind that, “the regulatory process holds promise. It’s just as easy to believe that CMS is going to do the right thing coming from the right place as it is to believe that they’re going to do the wrong thing coming from the wrong place. Let’s do everything we can to help them, and give them everything they need to make sure this benefit is perfected and not undermined. We are delighted to have the opportunity to advocate for all of you on behalf of hospice whether it be with CMS or with Congress.”
To hear the full teleconference, please click here.