There are some significant updates from the Centers for Medicare & Medicaid Services (CMS) that you’ll want to know about. They’ve just released the FY 2025 Hospice Payment Rate Update Final Rule, and it includes important changes to how hospices get paid, report quality, and operate. Let’s break down what this means for you and your team.
Payment Rate Updates
There’s good news on the payment front. Hospice payment rates are going up by 2.9% for FY 2025. This increase translates to an estimated $790 million more in payments compared to FY 2024. The statutory aggregate cap, which is the maximum total payment a hospice can receive, is set at $34,465.34 (CMS.gov) (CMS.gov).
Quality Reporting Enhancements
Quality care is always a priority, and CMS is making some changes to how quality is reported. The Hospice Outcomes and Patient Evaluation (HOPE) tool is set to replace the Hospice Item Set (HIS). This new tool aims to improve the collection of data on patient care and outcomes. Some new measures are being introduced, focusing on timely follow-up for pain and non-pain symptoms (CMS.gov) (CMS.gov).
Wage Index Updates
There’s also a change to the wage index, which adjusts payments based on local labor costs. CMS is adopting the latest Office of Management and Budget (OMB) statistical area delineations. To prevent drastic payment cuts, a 5% cap on wage index decreases will be in place (CMS.gov) (CMS.gov).
Changes to the Hospice CAHPS Survey
The Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Survey is getting a makeover. Changes include a new web-mail mode and a shorter survey. There are also new measures to assess care preferences and how well the care team communicates with patients and their families (CMS.gov) (CMS.gov).
Special Focus Program
CMS is stepping up oversight of hospices that consistently perform poorly. The Special Focus Program will use quality indicators to keep an eye on these hospices and help them improve. This is all about ensuring that all patients receive the best possible care (CMS.gov) (CMS.gov).
Technical Updates
There are also some technical updates to clarify the Conditions of Participation and payment regulations. These updates aim to ensure everyone is on the same page, particularly regarding the roles of medical directors and physician designees in certifying terminal illnesses (CMS.gov) (CMS.gov).
What Does This Mean for You?
So, why does all this matter? Well, these updates are designed to improve the quality of hospice care, enhance the accuracy of reporting, and ensure fair payment structures across the industry. Here’s how it could impact your day-to-day operations:
More Funds to Work With
The payment rate increase means more resources for patient care. With a 2.9% boost, there’s a little more financial breathing room.
Better Quality Reporting
The switch to the HOPE tool should make it easier to collect and report quality data. This is great for ensuring that patient care standards are being met and improved.
Stable Payments Despite Changes
The 5% cap on wage index decreases means that even if there are significant changes in your area’s labor costs, your hospice won’t see drastic cuts in payments.
Easier Feedback with a Shorter Survey
The changes to the CAHPS Hospice Survey should make it simpler for patients and families to provide feedback, leading to better insights into patient care and satisfaction.
Enhanced Oversight for Consistent Quality
The Special Focus Program will ensure that hospices maintain high standards, which is a win for patients and providers alike.
Clearer Guidelines
The technical updates provide clearer guidelines on certification and participation conditions, which helps avoid any confusion or compliance issues.
Looking Ahead
While there are many who support these changes, various industry groups, including the National Hospice and Palliative Care Organization and the National Association for Home Care & Hospice, have expressed concerns and suggestions about the proposed changes. Key issues raised include the fairness of the algorithm used for the Special Focus Program, which may not accurately identify hospices needing the most attention, and the potential negative impact on smaller providers due to skewed survey results.
As always, staying informed and adapting to new regulations is key to providing the best care possible. If you have any questions or need more details, you can check out the full rule on the CMS website.
And remember, whether it’s managing documentation, tracking patient care, or staying up-to-date with the latest regulations, WorldView is here to support you. Let’s keep making a difference, one patient at a time.
