CMS is expected to release the FY 2019 Hospice Payment update this week. Hospice has been a bit of a policy desert in recent years as no one quite knows what to do with it in the context of advanced medical practice for the treatment of cancer. In recent years, hospice has increasingly admitted patients with COPD and neurological diseases like Alzheimer’s and less so for cancers which are increasingly curable.
The payment update, which relies on the Inpatient Hospital Prospective Payment rate is expected to be:
What to look for:
Update on CMS’s review of the ACA-mandated changes to the Hospice payment system. For the last several years, CMS has provided annual updates on the impact of revising the Routine Hospice Care rate. Since the implementation of the new system, CMS has not had sufficient data to draw many conclusions. As the data matures, there should be more robust analysis and that could begin with the FY 2019 rule.
Changes to quality measures. CMS, starting with yesterday’s inpatient and long term care hospital rules, is tossing overboard quality measures they have deemed unnecessary or duplicative. Expect them to do the same for hospice care.
Recognition of physician assistants as attending physicians for hospice care. The Bipartisan Budget Act of 2018 extended the definition of attending physician in hospice care to physician assistants. CMS will probably use rulemaking explain how they will implement this provision.
Other policy signals. We aren’t expecting much but the FY 2019 rule could provide an opportunity for CMS to signal any intent they may have to modernize the benefit. It would take an act of Congress to make dramatic changes but CMS can still use rulemaking to express their concerns.