CMS responds to OIG concerns about hospice care in assisted living

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The Centers for Medicare & Medicaid Services indicated that it has not ruled out regulatory reform as it looks to discourage hospice programs from targeting some Medicare beneficiaries who live in assisted living communities, where care may result in more money for hospices.

The insight, made in reference to a January 2015 recommendation by the U.S. Department of Health and Human Services Office of Inspector General, was included in a proposed rule, announced by CMS on April 21, that would create two new quality measures as well as update Medicare payment rates and the wage index for hospices serving Medicare beneficiaries in fiscal year 2017.

“[T]he Office of the Inspector General (OIG) has raised concerns about the potential for hospices to target beneficiaries who have long lengths of stay or certain diagnoses because they may offer the hospices the greatest financial gain,” the proposed rule noted. “We continue to communicate and collaborate across CMS to improve monitoring and oversight activities of hospice activities. We expect to analyze more recent hospice claims and cost report data as they become available to determine whether additional regulatory proposals to reform and strengthen the Medicare hospice benefit are warranted.”

As McKnight's Senior Living previously reported, the OIG noted its 2015 hospice-related suggestion in its just-released 2016 “Compendium of Unimplemented Recommendations,” a list of the top 25 unimplemented ideas that the OIG believes “would most positively impact HHS programs in terms of cost savings and/or quality improvements and should, therefore, be prioritized for implementation.”

The findings in the compendium and other OIG reports “show that payment reform and more accountability are needed to reduce incentives for hospices to focus solely on certain types of diagnoses or settings,” the OIG said.

The proposed rule that CMS announced April 21 is scheduled to be published in the Federal Register on April 28 but is on display now as a PDF. Public comments will be accepted until June 20.

Among other things, the proposed rule indicates that hospices would see a 2% ($330 million) increase in their payments for FY 2017.

The rule also suggests two new quality measures for hospices. The first, Hospice Visits When Death is Imminent, is a measure that would assess hospice staff visits to patients and caregivers in the last week of life. The second, Hospice and Palliative Care Composite Process Measure, would assess the percentage of hospice patients who received care processes consistent with guidelines. This measure would be based on select measures from the seven that are currently being submitted under the Hospice Quality Reporting Program: pain screening, pain assessment, dyspnea treatment, patients treated with an opioid who are given a bowel regimen, and treatment preferences and beliefs/values addressed if desired by patient.

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