Hospice Issues
Here are the top issues at the state and federal levels for Ohio hospices:
State
Medical Orders for Life Sustaining Treatment (MOLST): Ohio patients need a better way to communicate their wishes at end of life. The Ohio Medical Orders for Life-Sustaining Treatment (MOLST) initiative, modeled after the national POLST paradigm (Physician's Orders for Life Sustaining Treatment) would allow patients, in conversation with their physician's, select from a range of end of life care wishes.
Providing Hospice Care Across State Lines: Many of Ohio's border regions are rural and remote, and frequently there are only a few healthcare providers to choose from. Recent changes in language and interpretation of regulatory guidance have further restricted patients' choice of healthcare provider in these regions, by prohibiting hospice programs to cross state borders in order to provide end of life care. Click here for the OHPCAN Talking Points on Providing Hospice Care Across State Lines.
Update the Definition of Palliative Care: Currently, the definition of Palliative Care in the state of Ohio is only located in the hospice licensure statute. It states that palliative care is care provided to a "hospice patient," and there is increasing concern that, if interpreted verbatim, this may mean that hospices providing palliative care services to non-hospice patients are in violation of statute. While no hospice has been penalized for violating this statute, OHPCO is acting preemptively to broaden the definition of palliative care, so that it is never interpreted to restrict patient care.
Carve Hospice out of Medicaid Managed Care: When Medicaid Managed Care Plans (MCP) were expanded to include the Medicaid's Aged, Blind and Disabled (ABD) group in early 2007, the nature of hospice care was not fully considered. Specifically, the fourteen-day authorization period allowed to MCPs is a glacial pace for end of life care. Between one quarter and one third of hospice patients die within the first 7 days of care, so even the 3-day ‘expedited' review process leaves a significant portion of patients without appropriate end of life care. Ohio hospices request that hospice care be ‘carved out' of Medicaid Managed Care, similar to the hospice ‘carve-out' in the federal Medicare program.
Federal
Hospice Reimbursement and Elimination of the Budget Neutrality Adjustment Factor (BNAF) Thankfully, the President's budget proposed a full market basket update to the hospice wage index, which allows hospices to cover the rising costs of wages, supplies and pharmaceuticals that they use in order to provide high-quality end of life care to patients and families. Furthermore, hospices are relieved that Congress included a one-year moratorium on an administrative cut to hospice rates by eliminating the budget neutrality adjustment factor (BNAF) from their reimbursement formula. Unfortunately in the current year-to-year healthcare financing context, hospices will be fighting this battle again come October 2009, when the moratorium will expire. Hospices nationwide will be facing a 4.6% cut, and Ohio hospices will be facing a 5.7% cut.
Ohio hospices ask their legislators to reign in runaway rulemaking and support legislation which would put a permanent block on the elimination of the BNAF. Click here for the OHPCAN Talking Points on the BNAF.
Data Collection: In 2007 and 2008, the Centers for Medicare and Medicaid Services (CMS) issued two Change Requests, which, among other changes, required hospices to begin reporting the location where hospice care is delivered and the number of visits by physicians, nurses, social workers and home health aides on claims.
Most troubling is that the kind of data and manner in which it will be collected will make the data gathered meaningless. To gather data, CMS is using claim codes used on home health Medicare claims, a throwback to fee-for-service Medicare. The fee-for-service model is largely culpable for the fragmented and uncoordinated healthcare system today, and accordingly, the data gleaned from its tools will only reveal a fragment of hospice care. Furthermore, healthcare reimbursement is shifting to quality-based payment, and the proposed data reveal nothing about quality of hospice care.
Ohio hospices ask their legislators to urge CMS to work collaboratively with the hospice industry towards data collection that will more accurately capture the full array of services provided under the Medicare hospice benefit, and that will encourage high-quality rather than high-quantity care. Click here for the OHPCAN Talking Points on Data Collection.
