Hospice 2.9% increase 'falls short'

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A 2.9% payment increase for hospice providers "falls short," according to Katie Smith Sloan, president and CEO of LeadingAge, an association of nonprofit providers of aging services.

Sloan was responding to the Centers for Medicare and Medicaid Services release of the FY2025 Hospice Payment Rate Update Final Rule.

"​​Good hospice care is a holistic, patient- and family-centered, compassionate approach to the dying -- and it can be a godsend. We recognize that a 2.9% is an increase, but given the challenges our mission driven and nonprofit members continue to navigate, particularly a very competitive labor market especially for registered nurses, the final rule falls short of the need."

CMS is allowing for LPNs and LVNs to conduct the follow-up visits for the new hospice quality measures, which will greatly reduce staffing burden for providers, but the agency did not finalize the ability to conduct these visits by telehealth.

"We still believe the collection of telehealth data is critically important to understand the characteristics of hospice providers and patient populations utilizing telehealth," she said. 

Also, a payment mechanism to account for high-intensity palliative care services was not finalized in this rule, according to Sloan.

WHY THIS MATTERS

CMS issued the 2025 Hospice Payment Rate Update Final Rule on July 30  updating Medicare hospice payment rates and the aggregate cap amount.

The 2025 hospice payment update is 2.9%, an estimated increase of $790 million in payments from 2024. This results from the 3.4% inpatient hospital market basket percentage increase, reduced by a 0.5 percentage point productivity adjustment. 

The 2025 payment rates for hospices that do not submit the required quality data would reflect the finalized hospice payment update percentage of 2.9%, minus four percentage points, which results in a -1.1% update.

The hospice payment update includes a statutory aggregate cap that limits the overall payments per individual that may be made annually to a hospice. The finalized hospice cap amount for 2025 is $34,465.34, compared to the 2024 cap of $33,494.01, increased by the 2.9% hospice payment update.

THE LARGER TREND

The rule finalizes the proposal to adopt the most recent Office of Management and Budget statistical area delineations, which impacts the hospice wage index and clarifies current policy related to the hospice "election statement" and the "notice of election," as well as adds clarifying language regarding hospice admission and certification of terminal illness. 

It summarizes public comments related to the request for information regarding implementing a separate payment mechanism to account for high-intensity palliative care services.

This rule also finalizes that Hospice Quality Reporting Program (HQRP) measures be collected through a new collection instrument, the Hospice Outcomes and Patient Evaluation (HOPE); finalizes two HOPE-based measures; and discusses the anticipated trajectory for future refinement. 

The rule summarizes public comments received on the request for information regarding potential social determinants of health (SDOH) elements and provides updates on health equity, future quality measures and public reporting requirements. 

Finally, the rule makes changes to the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Survey.    

The CAHPS changes being finalized are:

• The addition of a web-mail mode (email invitation to a web survey, with mail follow-up to nonresponders).
• A shortened and simplified survey.
• Modifications to survey administration protocols to include a prenotification letter and extension of the field period from 42 to 49 days.
• 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 CMS Hospice Special Focus Program will monitor hospices identified as poor performers based on selected quality indicators. Hospices selected for the SFP will be under additional oversight to enable continuous improvement. 

The Hospice Special Focus Program 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 final rule includes changes to the Overall Rating of this Hospice measure that are nonsubstantive and will not impact the SFP algorithm. 

Email the writer: SMorse@himss.org

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