Hospices fight Medicare cuts
WASHINGTON – The National Hospice and Palliative Care Organization has filed a lawsuit to stop a federal rule that would cut Medicare reimbursement rates for hospices across the country.
The NHPCO says the Bush administration proposal, if enacted, would have a direct, negative impact on care at the bedside for the nation’s most vulnerable populations and would “irreparably damage hospice programs.”
The rule was published in The Federal Register on August 1 and was scheduled to become effective October 1.
“The administration’s rule is arbitrary and capricious,” said J. Donald Schumacher, the NHPCO’s president and CEO. “It will force many hospice providers across the country to either significantly scale back the care they provide to terminally ill patients or to shut their doors altogether.”
The lawsuit, filed in U.S. District Court for the District of Columbia, requests an immediate injunction to prevent the rule from becoming effective.
Hospice care focuses on providing pain and symptom management to the dying. More than 1.3 million dying Americans received care from the nation’s hospice providers last year.
On April 28, 2008, the Centers for Medicare and Medicaid Services acted on a provision in the president's FY09 budget proposal that would cut hospice reimbursement rates, altering the wage index adjustment by phasing out the budget neutrality adjustment factor (BNAF) that was applied to the hospice wage index in 1997 to minimize the disruption in beneficiary access to hospice services.
If implemented, such a reduction would cut hospice reimbursement by almost $2.2 billion, Schumacher said. Average hospice reimbursement would be reduced from current levels by more than 4 percent.
“The rule is an effort by CMS to reduce hospice payments by regulation but does so without … virtually any data to back up its push to cut hospice care to the terminally ill,” said Jonathan Keyserling, executive director of the Alliance for Care at the End of Life.
Keyserling said that in creating the new rule, CMS failed to analyze whether and to what extent the BNAF has played in the growth in the number of hospices or in hospice expenditures since the hospice wage index was established in 1997.
He also said CMS failed to analyze the effect of eliminating this component of the hospice wage on hospices and Medicare beneficiaries in need of hospice care.
The rate cut would have a real impact on hospice patients and their families, said David Schwind, chief financial officer at Capital Hospice in Falls Church, Va.
“We currently offer bereavement counseling in the workplace, a grief camp for family members of the deceased and outreach to communities across the region,” said Schwind. “But as reimbursement cuts increase, these are the first programs to go. And as cuts grow, you even have to start looking at reducing the level of care.”
The NHPCO claims independent research shows that hospice saves the Medicare system money. The organization cites a 2007 Duke University study which found that hospice saves Medicare an average of $2,300 per patient, amounting to a total savings of about $2 billion a year.
The NHPCO also says hospice care is highly rated by family members of hospice patients and enables the patient to die at home in most cases.
