Proposed Fiscal Year 2025 Hospice Payment Rule
Author: Maxwell Healthcare Associates
Posted: April 2, 2024
On March 28, 2024, the Centers for Medicare & Medicaid Services (CMS) released the proposed rule (CMS-1810-P) for the Fiscal Year (FY) 2025 Hospice Payment Rate Update, unveiling a series of pivotal changes and updates designed to refine Medicare hospice payments and associated policies. These changes exist to streamline operations and reimbursements in the hospice space and bring many nuances to quality of care and reimbursement outcomes. With updates to payment rates, reporting practices, and Conditions of Participation, remaining informed on rulings is an essential aspect of agency success in the post-acute environment. The key changes are as follows:
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Payment Rate Updates and Aggregate Cap: In a bid to enhance the fiscal landscape, the proposed rule suggests a commendable 2.6% increase in hospice payments for FY 2025, projecting upwards of a $705 million boost from FY 2024. Such an augmentation not only reflects an acknowledgment of evolving operational needs but also underscores a commitment to ensuring equitable reimbursement across the spectrum of hospice care providers.
Furthermore, the proposed updates extend to the aggregate cap, with FY 2025 witnessing a set limit of $34,364.85. This aggregate update serves as a safeguard, fostering financial predictability and stability within the hospice sector. Notably, hospices grappling with alterations to geographic wage indexes may find solace in the provision allowing a 5% cap on any downward adjustments from the preceding year. This measure serves as a shield against undue financial strain, enabling providers to navigate fluctuations with resilience and clarity.
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Hospice Quality Reporting Program (HQRP): Embracing a forward-looking stance, the proposed rule introduces the Hospice Outcomes and Patient Evaluation (HOPE) instrument, preparing to supplant the prevailing Hospice Item Set (HIS) framework. This shift embodies a concerted effort to foster a culture of continuous improvement, arming stakeholders with a nuanced understanding of patient outcomes and experiences.
Furthermore, the proposed incorporation of two novel process measures into HQRP strengthens the trend of precision and accountability in the industry. By honing in on the timely reassessment of both pain and non-pain symptoms, CMS underscores its unwavering commitment to elevating the standard of care delivery. Additionally, the call for stakeholder input on potential elements pertinent to social determinants of health (SDOH) underscores a holistic approach to hospice care, acknowledging the multifaceted nature of wellness.
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Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Survey: Recognizing the pivotal role of patient feedback, the proposed rule advocates for a revamp of the survey methodology, envisaging the inclusion of a web-mail mode alongside revisions to existing measures. This concerted effort to modernize survey modalities underscores a commitment to accessibility and inclusivity, empowering patients to voice their preferences and experiences through channels tailored to their needs.
The introduction of the novel Care Preferences measure, coupled with modifications to existing metrics informed by survey experiment findings, epitomizes CMS's unwavering dedication to fostering a patient-centric care paradigm. By leveraging patient insights as a compass, providers can chart a course towards tailored, empathetic care delivery, ensuring that every voice is heard and valued.
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Hospice Conditions of Participation (CoPs) Technical Updates: Rounding out the proposed amendments are technical refinements aimed at aligning the CoPs with hospice payment requirements, further upholding clarity and consistency. These nuanced adjustments, spanning the election statement, Notice of Election (NOE), and physician roles in certifying terminal illness and admitting patients to hospice care, epitomize CMS's emphasis on regulatory coherence.
By aligning operational protocols with overarching regulatory frameworks, providers can navigate the complex terrain of compliance with confidence and efficacy. These technical updates represent not merely a regulatory overhaul but a testament to CMS's unwavering dedication to fortifying the foundation of hospice care delivery.
Overall, the proposed Fiscal Year 2025 Hospice Payment Rule embodies efforts towards innovation, accountability, and patient-centricity. As stakeholders, our collective engagement during the comment period will remain essential as these proposals adapt into actionable frameworks. Providers and industry leaders can shape a future where transparency, quality, and compassion intersect harmoniously, ensuring that everyone embarks on their end-of-life journey with dignity and comfort.
The MHA Difference
As new rulings continue to change the industry and build stronger quality outcomes for patients and clinicians; agencies must stay ahead of the curve of change to ensure positive outcomes and continued compliance. The strategic experts at MHA bring years of experience in the industry as practicing clinicians, administrators, and experts in analytics, operations, and clinical care. Our comprehensive due diligence assessments ensure your agency’s preparedness and compliance with all changing rules and provide necessary recommendations to thrive through continual CMS updates. With the upcoming emphasis on survey scores and CoP compliance, we offer tech-enabled solutions like NOTIFYnana, and nanaBEREAVEMENT, that empower timely feedback collection and bereavement personalization. If you are ready to adapt to these upcoming rulings and find your agency in a better position to uphold quality and reach ultimate satisfaction for caregivers and patients, MHA remains the ideal partner for your success. If you would like to learn more about our strategic integrations or tech-enabled solutions, contact us at [email protected], or visit www.maxwellhca.com.