Home Health & Hospice Week

The Comprehensive Care for Joint Replacement (CJR) model gives rise to another concern about hospice.

The National Hospice & Palliative Care Organization “strongly believes, and numerous studies have shown, that appropriate referral for hospice care results in high quality and more cost effective care, and we want to ensure that as CMS increasingly explores the use of alternative payment systems, beneficiaries’ access to hospice care isn’t adversely affected,” the trade group said in its letter on the Centers for Medicare & Medicaid Services’ proposed CJR rule. “We urge CMS to … en-sure that the bundled payment model does not result in inappropriate incentives or unintended consequences. For example, we would ask that CMS monitor hospice utilization by beneficiaries who have undergone LEJR procedures in hospitals subject to the bundled payment model in comparison to beneficiaries elsewhere, and determine whether any differences identified warrant further inquiry.”

Result: “As in the case of other medically necessary services that would improve a beneficiary’s quality of care and quality of life, we expect that CJR model beneficiaries will receive clinically appropriate referrals to hospice in a timely manner,” CMS responds in the final CJR rule. “We will be monitoring for access to care and delayed care and will take actions as described if problems are found.”

Bottom line: “We are finalizing our proposal to include hospice services in the CJR model episode definition,” CMS confirms.