ESSAY REQUIREMENT ADDED TO MEDICARE HOSPICE REFERRAL PROCESS
BALTIMORE, April 22 -- Starting next year, Medicare coverage of hospice care will require physicians to write a "short narrative" describing the patient's clinical condition, under a proposed rule.By John Gever, Senior Editor, MedPage Today
The requirement, to take effect in fiscal year 2010, comes on top of a planned 1.1% cut in hospice care reimbursement rates, according to the proposed Hospice Wage Index rule announced late yesterday by CMS.
The agency said it was concerned about a rising number of hospice patients who survive longer than six months.
Currently, physicians must certify that patients have a life expectancy of six months or less to trigger Medicare payments. But they are not required to explain their clinical judgment.
In the proposed narratives, to be required for every certification or recertification for hospice care, physicians would have to describe the clinical evidence supporting a life expectancy of six months or less.
CMS said the narrative requirement was recommended by the Medicare Payment Advisory Commission (MedPAC).
The number of Medicare-certified hospices has increased 70% since 1997 and the number of beneficiaries receiving hospice care has more than doubled, to nearly 1 million, according to CMS.
"MedPAC reports that through 2015, hospice expenditures are projected to grow at a rate that outpaces those projected for hospitals, skilled nursing facilities, physician services, or home health care," according to CMS' announcement of the plan for fiscal 2010.
The commission also found that an increasing proportion of hospice patients receive benefits for more than six months, with "significant variation in hospice length of stay."
The planned 1.1% cut in reimbursements is the net of a 2.1% increase calculated from Medicare's hospital "market basket" indicator of costs minus a 3.2% reduction triggered by the phase-out of the so-called budget neutrality adjustment factor.
This factor is a fiscal device first introduced in the 1990s throughout the Medicare system, which in hospice care has helped to prop up reimbursements.
Last year, CMS announced a plan to eliminate the adjustment over a three-year period. Congress later suspended the phase-out for 2009, but CMS intends to keep to its original plan to end it by 2011.
Hence, the proposed rule for 2010 calls for a 75% reduction, with the remaining 25% to vanish in 2011.
CMS said the phase-out would save $2.9 billion in Medicare costs over five years.
A spokeswoman for the National Hospice and Palliative Care Organization said the group condemned the net rate reduction and would seek to overturn it.
"We're very unhappy about a cut in reimbursement," said Judi Lund Person, vice president of regulatory and state leadership.
Although the phaseout of the budget neutrality factor was not unexpected, she said, "it is still going to be a big hit to providers."
But she said the organization supported the requirement for physician narratives as part of the certification process.
They may be helpful in other aspects of hospice administration, she suggested. "We want to make sure we have good evaluations," Lund Person said, especially in recertifications.
Medicare's total hospice payouts in 2010 are estimated at $13 billion, according to CMS.
The full proposed rule for 2010 is to be published in the Federal Register on April 24. CMS is accepting comments through June 22, after which it will issue the final rule.
Published: April 22, 2009
This new essay requirement is a hideous reflection of our federal government's intolerance of elderly, sick people. Socialized medicine will inevitably mean that we need for old and sick people to hurry up and die. We will not be able to afford to care for these people.
As a society, this attitude should enrage and embarrass us.