April 05, 2011

Wyden, Roberts Requires Changes to Medicare Hospice Reimbursement be Vetted by Pilot Program

Washington, D.C. – In an effort to protect and maintain hospice services for Medicare beneficiaries U.S. Senators Ron Wyden (D-Ore.) and Pat Roberts (R–Ks.) introduced the Hospice Evaluation and Legitimate Payment (HELP) Act.  This legislation would require any changes to hospice Medicare reimbursements be tested for two years in a pilot program to ensure they do not harm hospice centers in a way that would limit access to those who need it most.

“With changes to the hospice Medicare reimbursement formula on the horizon, we need to make sure that hospice facilities can continue to accept Medicare patients,” Wyden said. “This bill tests any and all changes to the new system to make sure they are not negatively affecting the hospice programs that many terminal patients and their families rely on in their final days.”

 “It is impossible to describe the value of hospice services to the patients and families, especially in rural areas, for which they provide selfless and compassionate care,” Senator Roberts said. “The HELP Act does as the title says and takes initial steps in helping our hospices in Kansas, and across the nation, continue to give the valuable care that patients and families need.”

A recent study suggests that the median Medicare profit margin for hospices could drop by 15 percent by 2019, with many entering the red and actually costing hospice service centers money.  
It is estimated that by 2019, 66 percent of all hospices could have negative Medicare profit margins. This could have a large impact on facilities serving rural areas. The HELP Act requires that all changes to Medicare reimbursement structure be vetted through a two-year pilot program so that potential negative effects can be discovered and mitigated before affecting patients. The bill amends the requirements that all hospice patients meet face-to-face with a doctor before admission to a hospice, by allowing nurse practitioners and physician assistants and others to conduct the required face-to-face interview. The bill also requires hospice facilities seek Medicare accreditation every three years – instead of the current eight years – in order to ensure quality services.