About Hospice Care
Hospice care is a comprehensive approach to end-of-life care that is designed to maximize comfort for a person who is terminally ill by reducing pain and addressing physical, psychological, social, and spiritual needs. Hospice care involves medical treatment of the terminally ill individual and the provision of supportive and bereavement services to the patient and the patient’s caregivers.
According to the Medicare Payment Advisory Commission, “Medicare began offering the hospice benefit in 1983, pursuant to the Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA). The benefit covers palliative and support services for beneficiaries who are terminally ill, with a medical prognosis indicating that the individual’s life expectancy is six months or less if the illness runs its normal course. A broad set of services is included, such as nursing care; physician services; counseling and social worker services; hospice aide (also referred to as home health aide) and homemaker services; short-term hospice inpatient care (including respite care); drugs and biologics for symptom control; supplies; home medical equipment; physical, occupational, and speech therapy; bereavement services for the patient’s family; and other services for palliation of the terminal illness and related conditions. Most commonly, hospice care is provided in patients’ homes, but hospice services are also provided in nursing facilities, assisted living facilities, hospice facilities, and hospitals. In 2019, more than 1.6 million Medicare beneficiaries received hospice services from approximately 4,840 certified providers, and Medicare expenditures totaled about $20.9 billion.
“Medicare is the largest payer of hospice services, covering about 90 percent of hospice patient days in 2017. Payments are made according to a fee schedule that has four levels of care: routine home care (RHC), continuous home care (CHC), inpatient respite care (IRC), and general inpatient care (GIP). The four levels are distinguished by the location and intensity of the services provided. RHC is the most common level of hospice care, accounting for about 98 percent of Medicare-covered hospice days in 2018…GIP is provided in a facility on a short-term basis to manage symptoms that cannot be managed in another setting. CHC is intended to manage a short-term symptom crisis in the home and involves eight or more hours of care per day, mostly nursing. IRC is care in a facility for up to five days to provide a break for an informal caregiver….Daily payment rates for hospice are adjusted to account for geographic differences in wage rates.”
Source: MedPAC 2020 Report to Congress (with updates)
HOSPICE AT NAHC
Much the same as the National Association for Home Care & Hospice (NAHC) does for its members in the Home Health and Home Care sector, we offer a wide array of Hospice-related member benefits. Those include:
INDIVIDUALIZED MEMBER SUPPORT
- MEMBER LISTSERVE: Discuss issues related to hospice operations with other members and the NAHC staff.
- HELP DESK: Direct and timely access to regulatory/operations specialists for inquiries on key issues in hospice.
- MEMBER CASEWORK: Research on member-specific regulatory and operational issues.
- IN-DEPTH CASEWORK SUPPORT: For cases requiring in-depth research, analysis, and support, NAHC may supply such additional support for a charge based on staff availability, i.e. assistance with writing plans of correction, assistance with developing forms, customized chart review for audits (SMRC, OIG, etc.), and customized education.
POLICY UPDATES/EDUCATIONAL GUIDANCE
- HOSPICE POLICY UPDATES: NAHC offers timely notification on key hospice policy changes via member listservs (discussion groups) and daily electronic newsletter.
- MEMBER RESOURCES: NAHC maintains a library of member-accessible toolkits and guidance on key regulatory/subregulatory requirements and operational issues.
- WEBINARS: NAHC offers numerous webinars on a monthly basis on a variety of crticial topics in home care and hospice. Attendance at some of these webinars is free of charge for anyone employed by a member agency. Other webinars are offered at deeply reduced rates for member agencies.
- LIVE EDUCATIONAL OFFERINGS: NAHC holds two major conferences annually, its Annual Meeting and the Financial Management Conference. Both of these conferences offer a wide array of sessions that focus on hospice financial, management, regulatory, quality, leadership, human resources, and operational issues. Employees of NAHC member agencies may attend at reduced registration rates.
DIRECT POLICY ENGAGEMENT OPPORTUNITIES FOR MEMBER AGENCIES
- NAHC members are given a variety of opportunities throughout the year for involvement in the policy-making process, including:
- Opportunities to provide recommendations for regulatory and legislative policy positions and priorities for action
- Grassroots action advocacy opportunities
- NAHC member agencies can also be more actively engaged in policy discussions through the following organizational bodies:
- NAHC’s Hospice Advisory Council (the Hospice Association of America) conducts in-depth review and discussion of pending and prospective issues in the hospice arena. The group meets at least monthly to discuss regulatory and sub-regulatory proposals, legislation, and any other issues that have the potential to impact hospice operations, clinical staff, and patients. The Council plays a significant role in the development of NAHC’s proposals/responses to federal agencies, Congress, and other policymaking bodies. NAHC welcomes broad involvement in the Advisory Council by member agencies and organizations.
- NAHC organizes additional “task groups” on an as-needed basis for in-depth engagement on specific issue areas. As with the Hospice Advisory Council, NAHC encourages broad member involvement in task groups and welcomes recommendations for the creation of additional task groups going forward. The first such task group that has been developed has regulatory/quality issues as its focus. The task group has been actively engaged in discussions related to the development of hospice quality measures and the hospice assessment instrument.