Medicare Hospice Reimbursement vs. Cost of Care in 2017

Check out the latest updates on Medicare Hospice Reimbursement for 2020 here
The cost of care and reimbursement are not always in sync with each other. As the federal government changes regulations on eligible hospice care and reimbursement, let's see how these numbers match up. We will look at the changing Medicare Hospice Reimbursement rates for 2017, as well as how this payment process differs relative to diagnosis, prognosis and different medical conditions.

Medicare Hospice Reimbursement Rates for 2017

Payments for the Fiscal Year 2017 will be increased by 2.1% over 2016 for Medicare Hospice Reimbursement. These hospice payment rates went into effect on October 1, 2016, and are effective through September 30, 2017. Hospices that do not report the required quality data as required by the Affordable Care Act will have payment rates reduced by 2 percentage points.

The current base payment rates include:

  • Routine Home Care (days 1-60) $190.55
  • Routine Home Care (days 61+) $149.82
  • Continuous Home Care Full Rate = 24 hours of care Hourly rate=$40.19 $964.63
  • Inpatient Respite Care $170.97
  • General Inpatient Care $734.94

(These are the base rates which then vary depending on the economic multiplier used for different parts of the country and rural vs urban communities.)

Additionally, the 2017 FY cap is $28,404.99.

Payments for Diagnosis vs. Prognosis
The Centers for Medicare and Medicaid Services (CMS) is currently in a debate on the topics of prognosis vs diagnosis in hospice care. The NHPCO, which advocates for hospice patients and care, argues that the CMS has gone too far in dissecting individual diagnosis, ignoring the overall prognosis of a patient when reimbursing for care of related conditions.

Much of this debate stems from the fact that people are entering hospice for different conditions now than when the funding and guidelines were created in the 1980's. Many patients need treatment for related conditions that may not be directly included in the terminal diagnosis, and hospice centers are being asked to do more with less funding.

Hospice Care Must Now Address Multiple Conditions
Hospice care in 1998 cost Medicare $2.2 billion, while costs in 2009 had skyrocketed to $12.1 billion. Many factors have contributed to this increase from inflation to an aging baby boomer population, but an unexpected contributor is the type of disease being managed.

In the past, hospice was typically reserved for cancer patients. Most of these patients were expected to survive around 60 days in supportive care. Newly covered diseases have been added to the Medicare provision beyond cancer, such as Alzheimer's and Parkinson's disease. While this expanded care provides humane services to many in need, it poses a quandary for a system designed around the specific cancer care model.

Parkinson's and Alzheimer's patients typically survive 100 days in hospice, longer than the 60-day average for cancer patients. This not only increases the hours of care needed, but also the number of both separate and related conditions that may arise.

As hospice care becomes more complex so too will the cost of care, with reimbursement becoming more difficult.

Concordance Healthcare Solutions has been serving the hospice industry for many years and is well aware of the difficulties currently being faced by hospice providers. Click the Hospice button on our website to learn more about our unique solutions to address the rising costs of providing hospice care. As we say, "Offering programs and tools that help to streamline every level of your supply chain from inventory management, to data analytics, to standardization and cost containment, Concordance is much more than just a medical supply distributor." 

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