The hospice industry will receive $340 million in increased payments in 2019, according to CMS’ final hospice payment rule posted Aug. 1 on the Federal Register. That’s nearly twice the payment increase from 2018.
 
Hospices will receive 1.8% more in payments.
 
The industry only received a 1% increase in 2018. That lower amount largely was due to a one-time, 1% reduction in the payment update because of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
 
 The 2019 payment increase is based on an estimated 2.9% inpatient hospital market basket update, reduced by a 0.8% multifactor productivity adjustment and a 0.3% adjustment due to the Affordable Care Act.
 
The hospice aggregate cap for 2019 will be $29,205.44. To get that figure, CMS takes the 2018 cap — $28,689.04 — and adds on the proposed payment update percentage of 1.8%.
 
Rule details increases for RHC
 
For hospices that submit quality data and provide routine home care (RHC), the payment rate for days one through 60 will be $196.25 in 2019, compared to $192.78 in 2018.
 
For days 61 and beyond, payments will be $154.21 in 2019, compared to $151.41 in 2018.
 
Continuous home care will pay $998.38, inpatient respite care will pay $176.01 and general inpatient care will pay $758.07.
 
 Hospices providing services in the urban West South Central and outlying regions and the rural New England region will experience the largest estimated increases in payments of 2.2% and 3.4%, respectively.
 
Hospices in rural areas in the Mountain region will experience the lowest payment increase — 1.4%.
 
More from the final hospice rule
  • Physician assistants (PAs) can be attending physicians. Effective Jan. 1, 2019, PAs will be recognized as designated hospice attending physicians just like physicians and nurse practitioners. Under the payment rule, “Medicare will pay for medically reasonable and necessary services provided by PAs to Medicare beneficiaries who have elected the hospice benefit and who have selected a PA as their attending physician,” CMS states in the final rule. This conforms to language from the Bipartisan Budget Act of 2018, which President Donald Trump signed in February. “Inclusion of PAs in the definition of attending physician for the Medicare hospice benefit will lead to more flexibility for hospice beneficiaries and providers alike,” CMS states. Hospices should note, however, that they must check their state requirements to ensure PAs are allowed to do this in their state. Since PAs aren’t physicians, they still can’t act as a hospice’s medical director or physician, and they can’t certify the beneficiary’s terminal illness. PAs can’t perform the required hospice face-to-face encounter for recertifications. Many commenters on the proposed rule mentioned that they eventually would like physician assistants to be able to provide face-to-face encounters. But the Bipartisan Budget Act of 2018 didn’t make changes to allow PAs to certify terminal illnesses or perform face-to-face encounters for Medicare beneficiaries, CMS notes.
  • CMS removes component measures from Hospice Compare. CMS no longer will directly display the seven component measures from which a composite measure is calculated on Hospice Compare. However, the public still will have the ability to view the component measures — in what CMS contends will be a way to avoid confusion on the website. “CMS plans to achieve this by reformatting the display of the component measures so that they are only viewable in an  expandable/collapsible format under the composite measure itself, thus allowing users the opportunity to view the component measure scores that were used to calculate the main composite measure score,” CMS says in a fact sheet about the rule.
  • PUF data will come to Hospice Compare. CMS will eventually post information from the Hospice Utilization and Payment Public Use File (Hospice PUF) and/or other publicly available CMS data to Hospice Compare. It plans to use information available in these public files to develop a new section of the Hospice Compare website that will provide additional information along with the HIS and CAHPS quality measures and demographic information that is already displayed. “The Hospice PUF contains information on utilization, payment (Medicare payment and standard payment), submitted charges, primary diagnoses, sites of service, and hospice beneficiary demographics organized by CMS Certification Number (6-digit provider identification number) and state,” according to the final rule. CMS provided several examples of data that could be posted. One is the percent of days a hospice provided RHC to patients, averaged over multiple years. Another would show the frequency with which patients with certain primary diagnoses were cared for by an individual hospice. This kind of data might help consumers during their hospice selection process, CMS notes. For example, a consumer might determine from it whether a hospice specializes in dementia or has experience caring for patients with the condition. And if patients have a need such as receiving hospice care in a nursing home, PUF information could help patients or their family members determine if a hospice in their area has provided care in that setting.
Related links: Read the final rule at https://bit.ly/2Axqt3v and a fact sheet about the rule at https://go.cms.gov/2LLv1bN.