Home Health & Hospice Week

“Hospice’s effect on net aggregate Medicare spending … is a topic of general interest to policymakers, researchers and stakeholders, so our work here is intended to contribute to that knowledge base,” MedPAC staffer Eric Rollins said in the meeting.

For the cap topic, MedPAC has found over-cap hospices have long lengths of stay and high margins, Rollins highlighted. MedPAC has repeatedly recommended lowering the cap amount.

Regarding nonhospice spending, Medicare spent about $1.4 billion on nonhospice services for hospice patients in 2022, Rollins noted. The commission has interviewed 12 varying hospices on the matter, which will inform its recommendations in its next report to Congress, Rollins indicated.

Finally, ESRD patient use of hospice is significantly lower than the general Medicare population. In 2021, 28 percent of Medicare decedents with ESRD used hospice, versus 47 percent of all Medicare decedents, Rollins cited. MedPAC is looking into possible access issues, noting that hospices must cover dialysis if it controls symptoms.

Commissioners Acknowledge Hospice Payment Rates May Not Cover Everything

At least one MedPAC commissioner seemed to find that idea unreasonable. “Why would a hospice ever take a beneficiary where the hospice is going to have to pay for the dialysis?” asked physician Lawrence Casalino with the Will Cornell Medical School.

“We do hear … concerns about the hospice per diem and whether it … matches up to what the cost of dialysis might be,” admitted MedPAC staffer Kim Neuman in the session.

Other commissioners listed concerns about expensive drugs for hemophilia, seizures, and other conditions. They also outlined some of the gray areas in determining hospice vs. nonhospice spending, among other topics.

“This hot potato topic … probably makes all of us nervous,” noted Commissioner Brian Miller, a physician with Johns Hopkins University.