As the smoke clears from the titanic battle over health care reform (and as ongoing skirmishes generate even more smoke), the National Hospice and Palliative Care Organization has provided analysis of what the massive bill contains for hospice providers and for end-of-life care in general. Most of what's in the final bill is quite similar to what I reported here back in January on what was in the reform bills at that time.
NHPCO now estimates that "productivity adjustment" cuts in hospice rates (actually reductions in the annual inflationary rate increases) could eventually cost hospices $6.8 billion, less than previously reported. NHPCO says that it is "still fighting" to lessen the impact of the cuts on hospice providers, even though the bill has passed. However, hospice rate cuts in the reform bill aren't slated to start until Fiscal Year 2013. In the meantime, NHPCO will be gathering more comprehensive economic data on the provision of hospice care to inform policy makers. With such a massive bill, further legislative tinkering in the next Congress is considered inevitable, and the national organization will try to use that tinkering to further offset cuts in the hospice rates.
Other end-of-life provisions in health care reform include concurrent palliative and aggressive care for children, demonstration projects to test concurrent care models for adults, and provisions aimed at advancing the science of pain management. There is an emphasis on quality measurement, public reporting of hospice quality measures and eventual value-based purchasing for hospices, based on quality measures and informed by updated hospice Medicare claims forms and cost reports.
Starting next January, patients enrolled on hospice care for more than six months will require an in-person visit by a hospice physician or nurse practitioner to assess whether they are still terminally ill and qualify for hospice care. It is not yet known if that visit can be billed by the hospice. Changes in the structure of the Medicare hospice benefit along lines the Medicare Payment Advisory Commission previously proposed are projected for 2013, although NHPCO is now working with the Moran Company, a Washington, DC, healthcare research firm, to collect more patient-level hospice data to help inform those changes.
It wasn't long ago that opponents of health care reform were screaming about "death panels" in a way that made it hard to think hospices weren't among those being targeted. Given what's in the health care reform bill that passed, I think it's safe to conclude that America's providers of end-of-life care, on the whole, fared quite well.
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