The U.S. Centers for Medicare & Medicaid Services (CMS) on Wednesday released the 2023 proposed payment rule for hospice providers, including a 2.7% per diem rate increase. The rule also contains a model for phasing in changes to the way CMS will use the wage index to inform payment rates in future years.
Through the phase-in plan for the wage index, the agency is changing the data sources it uses to adjust hospice payment amounts to account for differences in wage rates among markets. The implementation strategy is designed to minimize disruption as well as the monetary impact on providers.
“This proposed rule proposes a permanent, budget neutral approach to smooth year-to-year changes in the hospice wage index,” the agency said in a statement. “Specifically, we are proposing a permanent cap on negative wage index changes greater than a 5% decrease from the prior year (regardless of the underlying reason for the decrease) for hospices in the FY 2023 proposed rule.”
The pay raise comes at a time when hospice providers’ financial resources continue to be strained by expenses associated with the COVID-19 pandemic, plus price and wage inflation. Operators are also contending with labor pressures and lower patient lengths of stay.
If finalized as written, the rule would also raise the aggregate payment cap to $32,142, up a corresponding 2.7% from $31,297.61 in 2022.
In addition, the proposed rule starts the ball rolling on a web-based methodology for the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey, which historically has been done on paper.
Patients and families in increasing numbers are using this information when choosing a hospice. Likewise, referral organizations such as hospitals, primary care physicians and nursing homes are using the data to guide referral and contracting decisions.
CAHPS data are being incorporated into CMS hospice star ratings during 2022, according to the proposed rule.
The proposal also includes an update on the agency’s testing of the Hospice Outcomes & Patient Evaluation (HOPE) tool. The will replace the Hospice Item Set (HIS) quality reporting system when completed.
In contrast to the HIS system which extracts item set data from a patient’s medical record using a standardized mechanism, the HOPE tool will measure aspects of hospice care at different points in the patient’s experience.
“HOPE is an on-going patient assessment instrument designed to capture patient and family care needs throughout the hospice stay,” CMS indicated in the rule. “HOPE supports care planning, quality improvement efforts, and health and safety of patients enrolled in Medicare-certified hospices.”
