Eli's Hospice Insider

Agency to examine effects of two-tiered system.

If you think changes to your live discharge rates under hospice payment reform will slip by unnoticed, think again.

In the 2016 final rule for hospice payment, the Centers for Medicare & Medicaid Services noted that it will focus on live discharges under the new methodology. “We will monitor the impact of the new RHC rates policy based on claims data, including trends in discharges and revocations, and implement future refinements to the rates or policy changes, if necessary,” CMS noted in response to commenters on the proposed rule.

CMS has already had its eye on the live discharge issue, and the agency highlighted these 2013 statistics in the rule:

• Between 2000 and 2013, the overall rate of live discharges increased from 13.2 percent in 2000 to 18.3 percent in 2013.
• Hospices at the 95th percentile for live discharges discharged 50 percent or more of their patients alive.
• Hospices with high live discharge rates also, on average, provided fewer visits per week. Those hospices with live discharge rates at or above the 90th percentile provided 3.97 visits per week while hospices with live discharge rates below the 90th percentile provided 4.48 visits per week.
• Hospices with live discharge rates at or above the 90th percentile provided, on average, 1.91 SN or MSW visits per week versus hospices with live discharge rates below the 90th percentile provided 2.35 SN or MSW visits per week.

Note: See the rule at https://www.gpo.gov/fdsys/pkg/FR-2015-08-06/pdf/2015-19033.pdf .