It's final!
On Friday, CMS released the FY 2017 Hospice Final Rule.
Download your PDF version at https://www.federalregister.gov/public-inspection
Two New Hospice Process Measures
This final rule implements two new measures.
The first measure is the Hospice and Palliative Care Composite Process Measure—Comprehensive Assessment at Admission. This measure captures seven individual care processes gathered from current hospice item set (HIS) items currently used to calculate the seven component measures, requiring no new data collection beginning April 1, 2017 to calculate this measure using existing data items. The data from patient admissions on and after April 1, 2017 will be included in the composite measure calculation.
Table 18. Summary of Burden Hours and Costs
|
Regulation Section(s) |
OMB Control No. |
Number of Respondents |
Number Of Responses |
Burden per Response (hours) |
Total Annual Burden (hours) |
Hourly Labor Cost of Reporting ($) |
Total Cost ($) |
|
Hospice Item Set Admission Assessment |
0938- 1153 |
4,259 |
1,248,419 per year |
0.233 clinician hours; 0.083 clerical hours |
395,333 hours |
Clinician at $67.10 per hour; Clerical staff at $32.24 per hour |
$22,900,166 |
|
Hospice Item Set Discharge Assessment |
0938- 1153 |
4,259 |
1,248,419 per year |
0.150 clinician hours; 0.083 clerical hours |
291,298 hours |
Clinician at $67.10 per hour; Clerical staff at $32.24 per hour |
$15,919,423 |
|
3-year total |
0938- 1153 |
4,259 |
7,490,514 |
0.55 hours |
2,059,891 hours |
Clinician at $67.10 per hour; Clerical staff at $32.24 per hour |
$116,458,766 |
Hospice payment rates implemented as proposed
Hospices that receive their CCN after January 1, 2017 for the FY 2019 APU and
January 1, 2018 for the FY 2020 APU are exempted from the Hospice CAHPS® requirements due to newness.
As proposed, CMS finalized its proposal to use the pre-floor, pre-reclassified hospital inpatient wage index as the wage adjustment to the labor portion of the hospice rates. For FY 2017, the updated wage data are for hospital cost reporting periods beginning on or after October 1, 2011 and before October 1, 2012 (FY 2012 cost report data).
After considering public comments on the proposed rule, CMS codified its policy that once a quality measure is adopted, it be retained for use in the subsequent fiscal year payment determinations until otherwise stated, as proposed.
Medicare Choices Model
The Medicare Care Choices Model (MCCM) tests a new option for Medicare and dual- eligible beneficiaries with certain advanced diseases who meet the model’s other eligibility criteria to receive hospice-like support services from MCCM participating hospices while receiving care from other Medicare providers for their terminal illness. This model is designed to:
(1) increase access to supportive care services provided by hospice;
(2) improve quality of life and patient/family/caregiver satisfaction; and
(3) inform new payment systems for the Medicare and Medicaid programs.
Hospice Cap 2016
As proposed, for accounting years that end after September 30, 2016 and before October 1, 2025, the hospice cap is updated by the hospice payment update percentage rather than using the consumer price index for urban consumers (CPI–U). The 2016 cap amount is $27,820.75.
Hospice Claims Data Updates
Top Twenty Principal Hospice Diagnoses for FY 2015
|
1 |
331.0 Alzheimer's disease |
196,705 |
13% |
|
2 |
428.0 Congestive heart failure, unspecified |
115,111 |
8% |
|
3 |
162.9 Lung Cancer |
88,404 |
6% |
|
4 |
496 COPD |
80,655 |
6% |
|
5 |
331.2 Senile degeneration of brain |
46,843 |
3% |
|
6 |
332.0 Parkinson’s Disease |
34,957 |
2% |
|
7 |
429.9 Heart disease, unspecified |
31,906 |
2% |
|
8 |
436 CVA/Stroke |
29,172 |
2% |
|
9 |
437.0 Cerebral atherosclerosis |
26,887 |
2% |
|
10 |
174.9 Breast Cancer |
23,969 |
2% |
|
11 |
153.9 Colon Cancer |
23,844 |
2% |
|
12 |
185 Prostate Cancer |
23,293 |
2% |
|
13 |
157.9 Pancreatic Cancer |
23,127 |
2% |
|
14 |
585.6 End stage renal disease |
22,990 |
2% |
|
15 |
491.21 Obstructive chronic bronchitis with (acute) exacerbation |
21,493 |
1% |
|
16 |
518.81 Acute respiratory failure |
20,214 |
1% |
|
17 |
429.2 Cardiovascular disease, unspecified |
16,937 |
1% |
|
18 |
434.91 Cerebral artery occlusion, unspecified with cerebral infarction |
15,841 |
1% |
|
19 |
414.00 Coronary atherosclerosis of unspecified type of vessel |
15,689 |
1% |
|
20 |
188.9 Bladder Cancer |
11,648 |
1% |
Note(s): The frequencies shown represent beneficiaries that had a least one claim with the specific ICD-9-CM code reported as the principal diagnosis. Beneficiaries could be represented multiple times in the results if they have multiple claims during that time period with different principal diagnoses.