CMS proposes 2.6% payment increase for hospices

Hospice providers get a 2.6% increase in 2025 the proposed rule released by the Centers for Medicare and Medicaid Services.

This represents an estimated increase of $705 million in payments from 2024. 

The increase results from the 3% market basket percentage increase reduced by a 0.4 percentage point productivity adjustment. 

The proposed rates for hospices that do not submit the required quality data would be updated by 2.6% minus four percentage points, which results in a -1.4% update.

The hospice payment update includes a statutory aggregate cap that limits the overall payments per patient that may be made to a hospice annually. The proposed hospice cap amount for 2025 is $34,364.85, which is the 2024 cap amount of $33,494.01 increased by 2.6%.

This proposed rule proposes to adopt the most recent Office of Management and Budget statistical area delineations, which revises the existing core-based statistical areas based on data collected during the 2020 Decennial Census. 

Hospices affected by the change to their geographic wage index will be eligible for applying a 5% cap on any decrease to the wage index from the prior year. This permanent cap, finalized in the 2023 Hospice Final Rule, would prevent a geographic area's wage index from falling below 95% of its wage index calculated in the prior fiscal year.

This proposed rule also solicits comments from the public related to potential implementation of a separate payment mechanism to account for high-intensity palliative care services such as for palliative dialysis, chemotherapy, radiation and transfusions.

Public comments on the proposals will be accepted until May 28.

WHY THIS MATTERS: REACTION

LeadingAge said, "Any increase in payment is appreciated, but the proposed increase is not enough."

The association of nonprofit providers of aging services was excited to see the request for information around payment for high-intensity palliative services, since it aligns with its benefit reform proposal around concurrent care, according to LeadingAge president and CEO Katie Smith Sloan.

"The demand for hospice services is growing as our country's population is rapidly aging," Sloan said. "While any increase in payment is appreciated, we are disappointed with the proposed 2.6% payment increase from the Centers for Medicare and Medicaid Services. This is not enough for our nonprofit, mission driven hospice members who are struggling to keep up with both continued workforce shortages and inflation-driven operating expense increases."

Hospice Quality Reporting and Other Proposals

Under the proposal, Hospice Quality Reporting Program measures are being collected through a new collection instrument, the Hospice Outcomes and Patient Evaluation (HOPE).

The rule proposes two HOPE-based measures, the Timely Reassessment of Pain Impact and Timely Reassessment of Non-Pain Symptom Impact, expected to begin in 2028. These two measures would use the data that the new HOPE instrument will collect and would reflect whether a follow-up visit occurred within 48 hours of an initial assessment where there was an impact of moderate or severe symptoms with and without pain.

This rule also proposes to adopt and implement the HOPE patient-level data collection tool, beginning with FY 2025, and functionally replace the existing Hospice Item Set (HIS) structure. HOPE will collect data at multiple time points across the hospice stay, including admission, the HOPE Update Visit and discharge.

This is compared to HIS, which only collected data at hospice admission and discharge.

This proposed rule requests stakeholder input on potential data collection items related to four SDOHs (housing instability, food insecurity, utility and transportation challenges) that may be relevant to the hospice setting and how they may need to be adapted to be better suited for the hospice setting.

CAHPS

The rule also proposes changes to the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Survey based on the results of a mode experiment conducted in 2021. 

Specifically, the changes being proposed are:

• The addition of a web mail mode (email invitation to a web survey, with mail follow-up to non-responders),
• A shortened and simplified survey,
• Modifications to survey administration protocols to include a pre-notification letter and extended field period.
• The addition of a new, two-item Care Preferences measure,
• Revisions to the existing Hospice Team Communication measure and the existing Getting Hospice Care Training measure,
• The removal of three nursing home items and additional survey items impacted by other proposed changes in this rule.

The Hospice Special Focus Program (SFP) algorithm uses data from four measures related to caregiver experience collected by the CAHPS Hospice Survey, including Help for Pain and Symptoms, Getting Timely Help, Willingness to Recommend this Hospice, and Overall Rating of this Hospice. 

This proposed rule includes changes to the Overall Rating of this Hospice measure that are non-substantive and will not impact the SFP algorithm.

THE LARGER TREND

The 2.6% increase compares to the 3.1% increase in hospice payments in 2024. This was based on a market basket update of 3.3%, with an adjustment of 0.2%.

The final FY 2024 rates for hospices that didn't submit the required quality data was set at 3.1% minus 4%, which resulted in an update of -0.9%. 

Email the writer: SMorse@himss.org