The Medicare Payment Advisory Commission on Friday recommended that Congress increase payment rates for hospices by 1% in 2012, after approving a series of other post-acute recommendations on Thursday, including ways to monitor over-utilization and combat potential fraud and abuse in the home health segment.
Hospice payment update urged
Commission members approved a recommendation that provides no payment update for home health in 2012, and also proposed that the CMS re-base the segment's payment system in 2013, as opposed to the current timeline of 2014. In addition, MedPAC recommended that the HHS secretary and HHS' inspector general's office should conduct medical-review activities in counties where there is so-called aberrant utilization of home health services to combat fraud and abuse.
The advisory panel proposed that the HHS secretary should also revise the home health case mix system to rely on patient characteristics to set payment for therapy and non-therapy services, and no longer use the number of therapy visits as a payment factor. And the commission proposed that Congress should direct the HHS secretary to establish a per-episode co-payment for home health episodes that are not preceded by a hospitalization or post-acute-care use, meaning that beneficiaries coming out of hospitals or skilled-nursing facilities would not have a co-payment, but those coming directly from the community would.
For the hospice segment, the recommended 1% increase to the payment rate drew support from all but one commissioner, Mitra Behroozi, who abstained. A few commission members were wary of providing any increase for hospices because those facilities have become increasingly for-profit over the past decade, among other reasons.
The commission also resubmitted recommendations it originally sent to Congress two years ago that would tweak hospice payment systems and rules governing potential financial conflicts of interest.
MedPAC also recommended no increase in the reimbursement rates for long-term acute care hospitals. Commission members discussed the possibility of adding a separate rate increase in the future for LTAC hospitals that are small or rural because they tend to have lower profit margins, according to their data.
On Thursday, MedPAC recommended there be no payment updates in 2012 for skilled-nursing facilities and inpatient rehabilitation facilities. Earlier that day, the commission proposed that Congress update payments for the hospital inpatient and outpatient prospective payment systems by 1% in 2012.
MedPAC will include these recommendations in its report to Congress on March 15.
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