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Obama Signs Health Care Reform Bill - What's Next for Hospice?

By March 23, 2010

Most of us have already heard that the health care reform bill was voted through the House of Representatives and has now been signed by President Obama.  If you are like me, you're wondering "How will this affect me?".  I haven't quite figured that one out yet, although there are a lot of great resources her on About.com to help you understand that.  What I can help you understand is how this health care overhaul will affect hospice care as it stands now.  (The comments in parenthesis are just my personal take on each provision.)

1.  The bill softens the proposed cuts to Medicare from $10 billion to $7.8 billion. (This is still not enough of a reduction. These cuts on top of the more than 4% reduction associated with eliminating the budget neutrality adjustment factor (BNAF) is more than hospices can sustain.  Please visit NHPCO's Capital Hill Day Information Page to find out how you can help.)

2.  It includes a market basket reduction of .3% for hospice providers for years 2013-2019.  (Boo.  See above.)

3.  Payment reforms:  the Secretary would collect data on hospice claims, implement revisions for payment, and medically review hospices with a high percentage of long-length stay patients.  A physician or nurse practitioner must have a face-to-face meeting with a patient prior to the 180th day re-certification.  (Neutral)

4.  The bill directs the Health and Human Services Secretary establish a 3 year demonstration program in up to 15 hospices to allow hospice eligible patients to continue to receive all other Medicare covered services while on hospice care.  Then there will be an independent evaluation on patient care, quality of life, and Medicare spending.  (I like this provision A LOT and can't wait to see the results.)

5.  The bill allows children enrolled in Medicaid or CHIP to receive hospice services and curative treatments at the same time.  (Similar to the Nick Snow Act in California.  This is a great provision.)

6.  The bill creates an independent Payment Advisory Board that will present Congress with comprehensive proposals to reduce excess cost growth and improve quality of care for Medicare beneficiaries as well as those with private insurance.  Basically, if the spending of Medicare seems to be unsustainable, the proposals of the board will take effect, barring any action from Congress. (I'm not sure how to feel about this one.  Feel free to weigh in!)

7.  The bill provides the Health and Human Services Secretary authority to test value-based purchasing systems of hospice providers, no later that January 1, 2016. (Neutral)

8.  It requires hospices to report on quality measures or face a 2% reduction in their market basket update. (Ouch!  Holding hospices responsible for quality can only be a good thing.)

9.  It establishes a nationwide program for thorough state and federal background checks on all employees providing direct patient care.  (Hopefully most hospices do this already but this provision will ensure that they won't have to pay out of their already strapped budget to do so.)

10. The bill authorizes an Institute of Medicine Conference on Pain Care to evaluate the adequacy of pain assessment, treatment, and management.  Also authorizes the Pain Consortium at the National Institutes of Health to enhance clinical research on pain causes and treatments and a grant program to improve health professionals' ability to assess and treat pain.  (Yes!  We still have a long way to go in pain management.)

All of this information can be found in more detail on the National Hospice and Palliative Care Organization's (NHPCO) website.

April 6, 2010 at 10:46 am
(1) W. Brian Byrd MD says:

Thank you, Angela. I have shared your nice write-up with several people and just pasted it onto my hospice blog (with thanks to About.com).

April 8, 2010 at 2:45 am
(2) Ventura Hospice says:

Great blog i like to read this blog daily it has all the useful stuff, i would like to subscribe it so can you please tell me when your blog gets updated.

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