LeadingAge to Congress: Reform Hospice Benefit, Fund Palliative Care

The Medicare Hospice Benefit should allow some concurrent care, and Congress should support greater access to palliative care, among other reforms, according to LeadingAge.

The senior care advocacy organization wrote to Congressional leaders today calling on lawmakers to devote attention to improving the 40-year-old benefit. In addition to concurrent care, LeadingAge urged Congress and the U.S. Centers for Medicare & Medicaid Services (CMS) to modify rules for the four levels of hospice care, foster greater interoperability, examine nursing home relationships and other changes.

“We drafted these proposals, which include both big ideas as well as actionable fixes, with one goal: to make the hospice benefit work better, and to ensure it remains a sustainable and noteworthy benefit. The most common comment our hospice members hear from patients and families is, ‘Why didn’t I get your services sooner?'” Katie Smith Sloan, president and CEO of LeadingAge said in a statement. “Additions, including new levels of care and providing hospices with sufficient resources to pay for treatments that have a palliative intent but are, currently, cost prohibitive, would greatly increase access and utilization of the current benefit, thereby addressing this concern”

Advertisement

LeadingAge members include more than 5,000 aging services providers and other organizations that serve or advocate for seniors.

On the matter of concurrent care, LeadingAge and its members indicated that in the current system some patients have to give up treatments that have palliative effects because they are not sufficiently supported by the hospice benefit.

Examples include services like inotropic infusion therapy, which costs an estimated $150 per day, which ranges between 33% and 40% of a hospice’s per diem. Other treatments with palliative applications include chemotherapy and dialysis in some circumstances, LeadingAge noted.

Advertisement

“The policy goal is that by making it possible for coverage of treatments that have a palliative effect while on hospice will extend the length of stay in hospice care and enable more people to access the benefit in a timely manner,” the organization wrote to Congress. “For those who are electing a truly curative treatment (such as a third-line chemotherapy with the intent to cure the disease), we recommend that the billing remain the same while fixing issues with Part B palliative care to enable a more holistic experience.”

Regarding Part B palliative care, LeadingAge recommended improving access by developing better payment mechanisms, using an existing CMS comprehensive management and care coordination methodology.

This could benefit not only seriously ill patients in general, but could also help ensure continuity of palliative services for patients who are discharged alive from hospice, according to the advocacy group.

LeadingAge also recommended that:

  • Congress create a hospice room-and-board level of care that allows patients to die outside their homes without qualifying for general inpatient care or inpatient respite care
  • Congress instruct CMS to allow patients to receive the respite level of care in their homes
  • Federal lawmakers clarify minimum standards and the intent around the general inpatient level of care and instruct CMS to issue clarifying guidance accordingly for all its contractors and surveyors
  • CMS allow hospices to bill for continuous home care within any 24-window or, alternatively, create a modifier to indicate some hours utilized on a second day
  • Congress “deepen the U-Curve” to put more payment near the front of the benefit to help absorb the cost of short-stay patients
  • Federal agencies research the potential to set specific payment adjustments including in settings where additional professional staff can give some relief to family caregivers
  • Congress eliminate or modify the service intensity add-on due to the difficulty of predicting an exact date of death
  • CMS convene a technical expert panel and/or negotiate updated rules with stakeholders to ensure appropriate clinical responsibility and oversight for nursing home residents receiving hospice care.
  • Congress earmark more funds to develop nationwide interoperability of health IT and data sharing across the care continuum
  • CMS require hospice and palliative care training as part of all alternative payment models
  • Educational institutions like schools of medicine, nursing and social work schools should be required to provide training in goals of care conversations, hospice basics, and the difference between hospice and palliative care, among other suggested training requirements
  • Congress authorize study mechanisms to pay for high quality bereavement care, both as part of hospice and in the community

LeadingAge indicated that its members have mixed views on how to address the six-month terminal prognosis rule, which has become the subject of some debate and controversy in recent years.

One option would be for CMS to develop new methodologies for determining hospice eligibility, LeadingAge said.

“Hospices work with payers and partners that judge patients on a risk scoring system, Congress should instruct CMS to build a risk scoring system that takes into account those whose illness is advanced enough for hospice,” the organization wrote to Congressional leaders. “This, in combination with the HOPE tool, could serve as the basis for a future transition away from the prognostication standard.”

Companies featured in this article: