The State of Hospice and the View from Washington. President and CEO

Transcription

1 The State of Hospice and the View from Washington Don Schumacher, PsyD President and CEO National Hospice and Palliative Care Organization, 2012

2 BASIC HOSPICE DATA

3 Patients Served by Hospice in the US ,800,000 1,600,000 1,400, ,200,000 1,000, , , , , Number of Patients ts Number of Patients Source: National Hospice and Palliative Care Organization, 2012

4 Number of Hospices Number of Hospices Number of Hospices Source: Centers for Medicare and Medicaid Services, 2011 Data Compendium

5 Diagnoses of Hospice Patients 2010 Stroke or Coma 4.2% Other 54% 5.4% Lung Disease 83% 8.3% Liver Disease 1.9% Kidney Disease 2.4% HIV/AIDS, 0.3% Heart Disease 14.3% Dementia 13.0% Motor Neuron, 1.6% Debility Unspecified 13.0% Cancer 35.6% Source: National Hospice and Palliative Care Organization, 2012

6 Length of Stay in Hospice Da ays of Care Average Length of Stay Median Length of Stay Source: National Hospice and Palliative Care Organization, 2012

7 RATE CUTS A PRIMER

8 Rate cuts already in place Phase out of the BNAF FY2012 third year of seven year phase out Multiplier to the wage index reduced each year Invisible ibl to providers but shows up in wage index calculation of rates Completely phased out in FY2016 Productivity adjustment reductions Required in the Affordable Care Act Begins in FY2013 Original estimates of 1.1% for all Medicare providers Additional 0.3% for hospice providers

9 Productivity Adjustment Reductions Estimated marketbasket increase for FY2013: 24% 2.4% 1.4% (productivity adjustment reduction) 10% 1.0% marketbasket ktb ktincrease $ Routine home care rate in FY2012: $ Estimated FY2013 rate: $152.54

10 Super Committee failure Impasse announced in November 2011 Did not meet goal for identifying $1.2 trillion to reduce the federal deficit Next step sequestration Automatic across the board cuts for Medicare providers and defense spending No more than 2 percent reduction of overall spending on hospice and would last for ten years

11 Preparing your hospice for rate cuts Streamline operations and look for efficiencies Take a hard look at staffing and staff caseloads A good resource for this analysis is the NHPCO Staffing Guidelines, found at Look at service area reductions to cut down on mileage andstaff time costs and staff time costs Take a hard look at services that could be reduced without affecting patient care Look for ways to increase charitable giving as a way to cover some costs

12 What can be done? Sequestration: Cuts are technically triggered and already written into law NHPCO advocacy: Given the other cuts facing the hospice community, an additional 2 percent would be devastating to patient access Engage in discussions on any and all alternatives that Congress will be pursuing to avoid sequestration. We expect there to be many moving targets Vigilance will be key in 2012

13 Opportunities for advocacy The network is: Developing new ways to engage with Congress from home Organizing a Advocacy Intensive in June

14 HELP proposed legislation The HELP legislation, S722 and HR 3506, will: Expand the list of health care professionals to conduct the face to face to include: Physician assistants Clinical nurse specialists Will expand the timeframe for completion of face toface to up to 7 days after admission Will require a two year pilot of payment reform before finalizing Will require hospices to be surveyed every three years

15 2012 as an election year? Presidential election year Full House of Representatives One third of the Senate More attention paid to: Deficit reduction Attempts to reign in entitlement spending Hospice is a part of that discussion

16 Supreme Court Decision Decision is expected to come out in late June 2012 No information yet on impact NHPCO preparing scenarios

17 HOSPICE CHANGES DUE TO AFFORDABLE CARE ACT

18 Hospice Payment Reform ACA provision: Reform hospice payments no earlier than FY2014 Analysis of data currently underway CMS contractors continue to analyze Claims data Hospice cost reports Technical Expert Panel convened Meetings continue in June 2012

19 Models U shaped curve Higher payments at the beginning of care Higher payments at the end of care Lower payments in the middle of care Other options Goal: to align payments with cost of services

20 CMS Concurrent Care Demo 15 hospice sites nationwide Focused on Medicare patients Patients can receive both curative therapies and hospice care concurrently RFP to be released by CMS pending Congressional appropriation for demos

21 Concurrent Care for Children Medicaid and SCHIP Mandatory coverage Eligible ibl for hospice services All other services for which the child is eligible may continue to be provided

22 Resources Available Website: Download toolkit Review Questions and Answers from CMS about concurrent care for children 22

23 QUALITY REPORTING

24 First Year of Hospice Quality Reporting Quality Reporting Begins in 2012 Mandatory data collection period first year: Otb October 1, 2012 December 31, 2012 After 2012: The data collection period will be January 1 December 31 Reporting will be done annually The number and types of measures will increase

25 Measure #1: QAPI with 3 Patient Care-Related Measures Structural measure on QAPI with two parts: Confirmation of participation in a QAPI program that includes at least three patient care related performance measures Descriptions of all of the patient care measures in use duringthedatacollection data period. No results are required to be submitted, just patient care measures es

26 Measure #2: Pain Management Outcome measure that addresses pain brought to a comfortable level within 48 hours of the initial assessment. The measure, also known as the Comfortable Dying measure, was developed by NHPCO. Information on implementation and comparative reporting are provided on the NHPCO web site:

27 Mandatory Reporting Includes both QAPI structural measure and Pain Management measure (NQF #0209) Datacollection period: October 1, 2012 December 31, 2012 Data reporting deadlines: QAPI Structural measure: January 31, 2013 Comfortable Dying measure (NQF #0209): April 1, 2013

28 Miss the deadlines? Mandatory reporting Measures required no choice in what measures should be reported Hospices who miss the 2013 reporting deadlines dli will face a 2% cut in their hospital marketbasket increase (hospice reimbursement rate inflation i adjustment ) in FY2014

29 CMS RESOURCES CMS Hospice Quality Reporting web page Download Hospice Quality Reporting Fact Sheet 2/ Quality Reporting/ Help Desk: or by phone at

30 What other measures are being considered? Must be endorsed by the National Quality Forum (NQF) 14 measures related to palliative care and end of life approved in February 2012

31 Examples of Approved Measures Pain assessment Dyspnea assessment Opioids id with ihbowel regimen Treatment preferences documented Family Evaluation of Hospice Care (FEHC)

32 Next Steps Determine which measures will be required for FY2013 Announce through rulemaking sometimein in 2012 Each year additional i measures will be added d

33 Value Based Purchasing Also known as Pay for Performance Pilot to start by January 1, 2016 Based on hospice quality reporting

34 LEADERSHIP INTO THE FUTURE

35 Leadership in the future. Jim Collins Great by Choice Why do some companies thrive in uncertainty, even chaos and others do not?

36 Findings.. Leaders Not more risk taking, more visionary, more creative More disciplined, more empirical, more paranoid Innovation. Innovation by itself is not the solution More important ability to scale innovations, to blend creativity it with disciplinei Leading in a fast world... Fast decisions and fast actions sure way to get killed Great companies Changed less in reaction to radically changing world

37 Always remember.