The CMS has published a proposed rule (pdf) on the hospice wage index for 2012 that would increase payments to hospices by 2.3% next year.

The rule would also establish a new quality reporting system that is required by last year's Patient Protection and Affordable Care Act. In it, hospices would be required to submit quality data measures to CMS or else have their annual increase reduced by 2 percentage points beginning in fiscal year 2014. One of those measures—endorsed by the National Quality Forum—would measure the percentage of patients who experienced pain on admission to a hospice and whose pain was brought under control within 48 hours, according to the rule.

The other is a proposed structural measure that relates to participation in a quality assessment and performance improvement, or QAPI, program. “We believe that participation in QAPI programs that address at least three indicators related to patient care reflects a commitment not only to assessing the quality of care provided to patients but also to identifying opportunities for improvement that pertain to the care of patients,” CMS said in its 151-page rule. The agency said examples of these “domains of indicators” include providing care in accordance with documented patient and family goals, effective and timely symptom management, care coordination and patient safety.

Meanwhile, the rule would change how hospice patients are counted in 2012. While the current law requires CMS to impose a limit on the aggregate Medicare payments a hospice provider receives year, the rule would change the current calculation and also apply that method to past years in certain instances. But it would also give hospice providers the opportunity to maintain their current counting methodology.

Finally, the proposed rule would change the “face-to-face encounter” requirement by removing the stipulation that the hospice physician who performs the face-to-face encounter with the patient must be the same physician who certifies the patient's terminal illness.

CMS will accept comments on the rule until June 27.