Home Health & Hospice Week

Warnings: Rebasing cuts seem poised on the horizon.

As your costs rise, your reimbursement increase will fall for next year, according to the 2018 proposed rule for hospice payment.

The Centers for Medicare & Medicaid Services floats a 1 percent payment increase for fiscal year 2018, which starts Oct. 1, the agency says in the rule released April 27. (For specific service rates, see chart below.)

The rate hike will produce a projected $180 million increase over this year’s hospice spending, CMS notes in a fact sheet about the rule. But the bump is less than half of the 2.1 percent rise hospices saw last year (see Eli’s HCW, Vol. XXV, No. 29).

The cap amount will be $28,689.04, up from the 2017 cap amount of $28,404.99.

You can thank the Medicare Access and CHIP Reauthorization Act of 2015 for the low rate of increase, notes Judi Lund Person with the National Hospice & Palliative Care Organization. MACRA, which revamped how Medicare pays physicians, required a reimbursement boost of 1 percent or less for hospices, home health agencies, skilled nursing facilities, long-term care hospitals, and inpatient rehab facilities.

The low increase “definitely creates a financial challenge for hospice providers,” says Theresa Forster with the National Association for Home Care & Hospice. “For the last two years the Medicare Payment Advisory Commission has noted that regulatory burdens on hospice providers are higher than usual, and we’ve had several years of substantial cuts.”

If not for the MACRA limitation used to fund the physician payment changes, hospices would have received a pay increase of about 2.2 percent, notes The Health Group in Morgantown, W. Va., in analysis of the rule.

“We’re very concerned for hospice providers,” Forster tells Eli.

Note: See the final rule at www.gpo.gov/fdsys/pkg/FR-2017-05-03/pdf/2017-08563.pdf.