Medicare has released the Hospice Wage Index for Fiscal Year 2008, but more noteworthy is everything else they released with it. This link will take you to the seventy-eight page file for your own reading enjoyment. Hopefully, you are smarter than me, because I can never read this stuff and make much sense out of it. They say that baseball is fifteen minutes of action crammed into three hours. Medicare releases are much the same, four important paragraphs crammed into seventy-eight pages.
According to my reading of the document and NHPCO’s five page summary (members only link) there are a few very noteworthy items here.
First, CMS is dedicated to tying payments to location, and make a strong case for it. Basically, they believe that some hospice companies have been taking advantage of the fact that General Inpatient Care is paid based on the location of the companies offices instead of the location where the care is given. Thus, companies have been locating their offices in high reimbursement locations, but contracting for GIC in low payment locations and keeping the difference. They seem dedicated to ending that practice.
The also are trying to end the use of General Inpatient Care for “Caregiver Breakdown”. Currently, hospices admit patients to General Inpatient Care when there is a family meltdown that results in the patient no longer having a safe living environment. The new rule would limit GIC to patients that actually have a need for intense care to control pain or manage symptoms. No more billing Medicare for the extra care patients need when their caregiver network fails. It is a big change, but, since I have used this blog to argue the need for CMS to make “smart cuts”, one I can live with.
To be clear, Medicare doesn’t actually see any of this as making cuts to hospice. In their minds this is how it should have always worked, and they are just making sure hospices understand the rules. These are “clarification” points and do not require a change in rules. To most providers these will feel like changes in rules, because it is a change in how existing regulations are being interpreted.
After all of that fun and games is the announcement of the actual Hospice Wage Index for FY 2008. This is the percentage of the actual payment rate that you get to keep depending on where a patient lives. There are always areas that get good news and areas that get bad news. Personally, the areas that my hospice serves are seeing a very slight increase. Not great news, but there is always the feeling that we have dodged a bullet. Of course, CMS won’t tell us how much the payment rate is until late in the summer, so today’s information is useless until then.
Changes are coming, and we’ve seen the first signs today.