Home Health & Hospice Week

Penalty for discharging early to hospice would limit hospice access.

The new bill passed by the House to avoid the Feb. 8 government shutdown has numerous home health agency provisions, but hospices don't escape untouched.

The "Further Extension of Continuing Appropriations Act, 2018," calls for the Centers for Medicare & Medicaid Services to implement a payment penalty for hospitals that discharge patients to hospice "early." The hospital DRG payment would be prorated based on how early the discharge would be.

The HHS Office for Inspector General made this recommendation last year in its 2017 "Compendium of Unimplemented Recommendations" (see Eli's HCW, Vol. XXVI, No. 20). The OIG annually releases the report on ways to curb fraud, abuse, and waste.

The bill would soften the blow by also requiring a study on the impact of the change conducted by the Medicare Payment Advisory Commission. The study would evaluate the change's "effects on (A) the numbers of discharges of patients from an inpatient hospital setting to a hospice program; (B) the lengths of stays of patients in an inpatient hospital setting who are discharged to a hospice program;" and "(C) spending under the Medicare program" as well as "other areas determined appropriate by the Commission."

The study would evaluate "whether the timely access to hospice care by patients admitted to a hospital has been affected" by the payment change, the legislation adds.

MedPAC would have to report its preliminary results to Congress in 2020 and its final report in 2021, according to the bill.

Whether this provision will make it into the final version of the law, which would fund the government through March 23, has yet to be determined.