Home Health & Hospice Week

Demographics, travel time, wage index work against rural providers.

The proposed 2.6 percent increase to Medicare hospice payment rates is a disaster all around, but one segment of the industry could take the inadequate pay bump especially hard.

“The current workforce crisis has created access issues across the country for individuals seeking hospice services and rural communities, which have larger portions of the aging population, have been hit hardest,” maintains trade group LeadingAge in its comment letter on the 2025 hospice proposed rule.

“It is crucial for CMS to recognize that hospice payments … are exceedingly tight, particularly in small, rural areas where the need is significant,” stresses the Hospice & Palliative Care Association of Iowa. “Rural providers must travel farther to serve fewer patients while navigating onerous state and federal regulations,” says Erin Cubit in the trade group’s comment letter. “Competing for … workers amid rising salaries is challenging, especially for rural hospices without adequate reimbursement rates,” Cubit adds.

“For our footprint which contains rural geographies, the ability to serve rural beneficiaries is significantly impacted as caseloads for teams serving rural beneficiaries is less than those in urban areas due to distance and travel,” explain Krista Bishop, Jenn Ofelt, and Cathy Simmons, with UnityPoint Health and its hospice and home health divisions, in the health system’s comment letter.

Medicare’s wage index system doesn’t help matters, with neighboring counties sometimes having drastically different wage index numbers, even when served by one agency, notes Tom Koutsoumpas of the National Partnership for Healthcare and Hospice Innovation in NPHI’s comment letter.