Theresa Forster is vice president for hospice policy & programs at the National Association for Home Care and Hospice (NAHC). She coordinates the organization’s legislative, regulatory, and other efforts on behalf of hospice providers.
She came to NAHC in 1996 after serving as director of the Special Committee on Aging of the U.S. Senate, where she directed investigations into concerns related to the nation’s seniors.
Hospice News sat down with Forster at the NAHC Financial Management Conference in Chicago to discuss new legislation on palliative care, the 2022 final hospice rule and the changing regulatory survey process.
There was a bill introduced last week regarding a Center for Medicare & Medicaid palliative care demonstration. There’s been a lot of discussion for a number of years about CMMI doing this on its own through its demonstration authority. What might the impact of congressional action be? Would that change the game in any way?
The most important part of folks in Congress wading in is that it lets [the U.S. Centers for Medicare & Medicaid Services (CMS)] know that there’s a strong interest in Congress. That really does give the system a little bit more ballast. Congress is letting them know they’re heading in that direction. I think that’s the biggest issue.
The Fiscal Year 2022 hospice final rule came out just a couple of days ago. Within that there was the Hospice Care Index group of quality measures. What was CMS trying to accomplish with those?
The Hospice Care Index is an interesting approach by CMS. They’re creating a measurement protocol and the quality measure. We’ve had a concern as we look at the different number of elements — some of which relate to program integrity, or performance measures, rather than quality. Those elements aren’t necessarily directly linked. CMS is obviously going forward with it. We’re hopeful that over time they may be able to come up with other elements that might be more appropriate than some of those that have been included in the measure.
But this is the direction that we’re headed. They’re very interested in looking at claims data, because that’s something that they can easily point to, and it doesn’t have to be an additional burden on providers. All of that adds up to an index that provides a measure, but all of it doesn’t necessarily need to qualify.
When you looked over the rule did you see anything that was surprising, disappointing or particularly positive?
We hoped that they would reconsider some aspects of the Hospice Care Index, but they were so far down the road that it’s clear that they didn’t.
What I found sort of gratifying was when you look at the labor shares section — of course, that’s a complex calculation — CMS seemed to have really examined the public comments. They obviously responded to some of them by saying they don’t agree. But what they did was a recalculation based on some of the input, and that increases the value to a lot of providers. That’s a really positive thing that they listened. They took the trouble to review their calculations and recognized that they needed change.
They also gave a lot of valuable feedback on the comments, even those comments that they didn’t ultimately agree with. Those of us who work with people in industry, vendors, consultants, folks from hospices themselves, had the opportunity to take a look at what they have learned and see if there is some additional work that we might do with CMS — particularly with improving the quality of the cost reports so that in future years, they can even better represent what is actually costing hospices.
I was really pleased to see that they were open to talking about possible changes. I also thought that just the fact that they made as many changes as they did to the election statement addendum was encouraging. All of those issues were taken to CMS during the last two years.
One area of concern around the Special Focus Program proposed recently in the home health rule was that the process was modeled after an existing system for long term care, kind of a quota system. Do you have concerns about that? How might that affect providers?
It does appear that there is some movement in CMS in the direction of what we were concerned about, because if in a particular state there’s nobody who’s eligible for a Special Focus Program, then we’re not going to have somebody designated. That’s a very positive thing, but we still would like to see additional work on the Special Focus Program.
One of the things that we really tried to focus on was the importance of education to providers. Yes, it’s important to punish people who do bad things, but in many instances the real key to performance is education. That’s one of the areas in which we would like to see a little bit more focus.
We also still are concerned that it’s not going to necessarily be a national program, because they’re going to focus on particular states’ priorities. You can argue both sides and say, well, we focus on scope because different localities have specific issues. On the other hand, if we are going to be identifying hospices as appropriate for Special Focus Programs, then there should be some continuity in terms of the severity of their deficiencies.
There’s a lot of room for ensuring that this program approaches things like that. We want it to be as perfect as possible, because we think that’s what is going to make the difference.
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