This evening, CMS released its final FY 2019 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements. The final rule updates hospice payment rates for FY 2019 and finalizes CMS’ proposal to allow physician assistants as designated hospice attending physicians effective January 1, 2019. The rule also includes changes to the Hospice Quality Reporting Program.
As in its proposed rule, CMS notes significant growth in hospice utilization, with expenditures increasing from $2.8 billion in FY 2000 to $17.7 billion in FY 2017. The CMS actuaries predict that hospice expenditures will continue to climb by 8 percent annually. Additionally, the diagnoses that lead to hospice utilization have changed over the same period, with lung cancer as the most common in 2002 and Alzheimer’s disease in 2017.
Slightly lower rate increase for hospice payments than proposed
While CMS had proposed a 1.9 percent increase in hospice payment rates for FY 2019, updated hospital inflation data now leads CMS to finalize a 1.8 percent increase. Nevertheless, CMS still believes that this will lead to an increase in payments to hospice providers of approximately $340 million, with slightly more of the increase accruing to rural hospices. For those hospices who do not submit required quality data, payments will actually decline by -0.2 percent (i.e. 1.8 percent minus 2 percent).
The hospice cap amount, as proposed, will also increase by the hospice payment update amount to $29,205.44 (previously $28,689.04).
Physician assistants may serve as attending physicians
Under the hospice benefit, the beneficiary agrees to cease treatment for their terminal illness except when provided by their designated hospice and attending physician. Currently, that physician may be a doctor of medicine or osteopathy or a nurse practitioner, and is the individual that has the most responsibility for the beneficiary’s medical care. The Bipartisan Budget Act of 2018 added physician assistants to that list, and CMS has now finalized conforming amendments to its hospice regulations as proposed. PAs will be paid 85 percent of the fee schedule amount for their services.
CMS adopts meaningful measures framework for hospice quality reporting
As with a number of its other benefits, CMS is adopting the meaningful measures framework for hospice reporting that it claims will improve patient outcomes and reduce provider burden and paperwork. No changes to the hospice program have yet been proposed, but CMS hints that future changes will be made consistent with this framework. CMS also continues to investigate ways of adjusting for social risk factors in quality reporting, but has neither proposed nor finalized any changes to that effect. CMS finalized its proposal to add an additional measure removal factor: the costs associated with a measure outweigh the benefit of its continued use, but has not yet removed any measures as a result. This rule finalizes proposed changes to the hospice quality reporting timeline, specifically limiting the time for data correction.