Home Health & Hospice Week

Industry reps declare victory.

Hospices are catching a break from Medicare for once. In a surprise move, the Centers for Medicare & Medicaid Services has reversed course and decided to wrap up its Medicare Advantage hospice carve-in at the end of this year.

“After carefully considering recent feedback about the increasing operational challenges of the Hospice Benefit Component and limited and decreasing participation among [MA Organizations] that may impact a thorough evaluation, CMS has decided to conclude the Hospice Benefit Component as of December 31, 2024, 11:59 p.m.,” the agency says in its notice about the termination on the Value-Based Insurance Design Model section of its website.

Just a year ago, CMS announced that it would extend the program until 2030. Now, the agency says it “will not accept applications to the previously released CY 2025 Request for Applications for the Hospice Benefit Component of the VBID Model.”

This out-of-the-blue announcement is “stunning,” The Health Care Group in Morgantown, W. Va. notes in its electronic newsletter.

“This is a huge victory for patients’ access to quality care and for hospice providers who have continually identified challenges with this demonstration including concerns about VBID giving MAOs the ability to limit patient choices,” the National Hospice & Palliative Care Organization’s Ben Marcantonio says in a release.

Attorney Brian Daucher with Sheppard Mullin in California has “seen many of my clients have to scramble for contracts with MAOs” in the program, Daucher tells AAPC. “Hospice will be a better product for consumers if left out of MA. In MA, a few providers get contracts, and others would be shut out of certain markets, with the result being less choice for beneficiaries in terms of hospice care, and probably care that is just not as good,” Daucher judges.

The National Association for Home Care & Hospice is “pleased to see [CMS’ Center for Medicare and Medicaid Innovation] has decided to end this particular demo,” the trade group says in its member newsletter. Hospices have had “ongoing concerns and frustrations with the demonstration and … deep skepticism that the model was necessary or appropriate for hospice patients and families,” NAHC relates.

Bottom line: “The model has been extremely burdensome for both hospices and participating plans, and has had no measurable positive impact on beneficiary or family outcomes, care experiences, or Medicare spending,” NAHC maintains.

In particular, the model has “fail[ed] to fully consider the implications for non-profit, mission-driven providers, patients, and their families,” the National Partnership for Healthcare and Hospice Innovation trade group charges in a statement.

Near Miss: As the carve-in rolled on, “most nonprofits were expected to be at a dangerous competitive disadvantage in contracting with payers, especially in competition versus for-profit providers that have lower-cost operations spread over huge geographies,” observes consultant Sue Lyn Schramm with Schramm Consulting in Aldie, Va., in a blog post about the termination.

“Palliative care may have some benefits in reducing costs of care to chronic 'highfliers,’” [but] I have always questioned managed care for hospice,” notes attorney Robert Markette Jr. with law firm Hall Render in Indianapolis. “By definition, hospice only has one outcome. We already limit hospital use and ER utilization, because the hospice is on the hook for everything related to the palliation of the patients’ symptoms,” Markette tells AAPC.

Result: “Running hospice in a managed care environment did not present any obvious path for additional savings or efficiency,” Markette concludes.

“On top of that, any additional confusion or lack of clarity for the patient was an added detriment” Markette adds. “A patient, and their family, facing the decision to elect hospice just want to focus on care, not which payer program they are dealing with,” he notes.

“I think this is for the best and was not surprised that it didn’t turn out to be as popular as Medicare thought,” he adds.

Think ‘Value’ Going Forward

Hospices can enjoy their respite from MA inclusion. But that doesn’t mean they should ignore managed care altogether, experts warn.

“Think again if you believe this means the hospice sector can just go back to business as it used to be,” Schramm warns. “The truth is the need to contract with MAOs for services will continue, just without the specific design and limitations of the proposed carve-in,” she stresses.

Risk: “This policy change may cause hospices to be further sidelined as a shrinking part of the healthcare continuum,” Schramm worries. With Medicare beneficiaries electing MA at increasingly higher rates, hospices may “risk becoming increasingly irrelevant in a world where palliative care is delivered by non-hospice providers, and lengths of stay in hospice grow ever shorter,” she cautions.

Do this: Hospices should “collaborate effectively with value-based payers, and foster open dialogue among like-minded organizations focused on pathways for future success,” NPHI urges.

“There are still new opportunities for developing value-based payment arrangements with Medicare Advantage,” Schramm points out. “Hospice and palliative providers will still need to be experts at analyzing their financial data, patient demographic mix, ability to avoid rehospitalization, and quality metrics,” she says.

For example: “We saw great success with concurrent care tested through the Medicare Care Choices Model (MCCM) and would encourage CMMI to consider these learnings as a potential path forward,” NHPCO says.

“We look forward to continuing to work with [CMS] to advance innovation in care delivery and payment models for people with serious illness,” NAHC says.

Meanwhile: The VBID carve-in isn’t going away overnight, experts stress. The program will continue as scheduled for the rest of this year — probably.

CMS does acknowledge that “later this year, [it] will issue additional guidance to ensure that all obligations of any impacted organization may be met in a timely and reasonable manner so that hospice beneficiaries in the Hospice Benefit Component maintain a coordinated, seamless care experience.”

The contents and timing of that guidance are unclear, NAHC notes.

In other words, stay tuned.

Note: CMS’ announcement is online at www.cms.gov/priorities/innovation/innovation-models/vbid/vbid-hospice-announcement.