Hospice reform efforts should focus on allowing for “more care, not less,” according to National Alliance for Care at Home CEO Dr. Steve Landers.

Key elements of this should include home-based respite care and a payment system for high-acuity palliative services that hospice patients often lose out on due to the costs. These can include services such as palliative radiation, chemotherapy, dialysis and blood transfusions, among others.

“It means innovation in care, home-based respite services, better payment models for people that need things like dialysis or palliative radiation,” Landers said at the Alliance’s Financial Summit in Chicago. “That is that reform we’re talking about.”

National Alliance for Care at Home

Landers indicated that any government attempts to “reform” the hospice industry should not focus on rebasing payment rates or instituting reimbursement cuts as the home health sector has seen.

Some stakeholders have advocated for the establishment of a reimbursement model or payment add-on to better cover the costs of those high-acuity palliative treatments. This was also a provision of the Hospice Care Accountability, Reform and Enforcement (Hospice CARE) Act, which was introduced in Congress last year but died in committee. 

Landers also said that attempts at hospice reform should not “carve-in” hospice into Medicare Advantage. Bringing hospice under Medicare Advantage would undermine patient choice, adversely impact timely access to care and leave providers with lower reimbursement rates, according to the Alliance, the National Partnership for Healthcare and Hospice Innovation (NPHI) and LeadingAge.

Those three organizations, the largest representing hospice providers in the United States, wrote to Rep. David Schweikert (R-Ariz.), who recently introduced the Medicare Advantage Reform Act. If enacted, the bill, numbered H.R. 3467 would make widespread changes to the Medicare Advantage (MA), including a hospice carve-in. The trade groups’ letter opposed that course of action.

“There have been a few folks floating the bad idea of bringing hospice closer into Medicare Advantage. As you know, hospice was established as its own care management model, its own managed care model, and that was the congressional intent …” Landers said at the conference. “There’s really not a problem to fix here. We are vehemently opposed to that idea. We think it is not the right thing for people with serious illnesses. It’s something that we’re going to have to activate and work very hard on to keep hospice the way that Congress intended as an independent care management model.”