The burgeoning use of the Medicare hospice benefit is causing congressional advisors to recommend a close look at the industry.
"From 1998 to 2002, the percentage of beneficiaries using hospice before they died grew from 16 percent to 25 percent in fee-for-service and from 25 percent to 34 percent in managed care," the Medicare Payment Advisory Commission notes in its June report to Congress. For-profit ownership grew from 31 percent of hospices in 2001 to 36 percent in 2003, the report says.
"For-profit hospices grew in number by 25 percent, significantly more than facilities with other types of ownership," MedPAC points out.
"The strong growth in the number of for-profit hospices may suggest that the financial environment for providing hospice care may be attractive for some providers," the commission warns Congress. MedPAC urges a close review of hospice payment rates "to assure that payments accurately account for efficient provider costs." It recommends examining potential payment adjustments for case mix, length of hospice enrollment, care settings, geographic variation and hospice eligibility (change in the six-month prognosis). The commission also would like to see quality measures for hospices and a different arrangement for managed care enrollees seeking hospice care. The hospice section of the report is at
www.medpac.gov/publications/congressional_reports/June04_ch6.pdf. The feds' scare tactics seem to be helping collect data for the Comprehensive Error Rate Testing project (see Eli's HCW, Vol. XIII, No. 14). The first year the Centers for Medicare & Medicaid Services took over the error rate project from the HHS Office of InspectorGeneral, "CMS experienced a significant problem with providers that did not respond to requests for medical records for use in developing the Medicare payment error rate," the OIG says in a report issued June 16. Since intermediaries and the OIG have started contacting providers, "these corrective actions appear to have increased provider responsiveness to requests for medical records," the OIG judges. But it's not all cleared up -- don't be surprised if you hear from the OIG soon. "We are concerned that as of April 8, 2004, providers had failed to submit medical records supporting 2,239 of the 126,618 claims in the FY 2004 sample, despite repeated requests for the records," the watchdog agency says. "Therefore, we have initiated an indepth review to determine why providers failed to respond." The DME competitive bidding project is picking up more steam. In addition to taking nominations for the advisory committee (see Eli's HCW, Vol. XIII, No. 21), CMS has awarded a contract for the bidding project to Research Triangle Institute in Research Triangle Park, NC. "The purpose of this contract is to assist CMS in developing options and recommendations on effective strategies and designs for implementing the national durable medical [...]
