In an evolving payment and regulatory environment, hospices would benefit from strengthening their engagement with federal, state, and local agencies and legislators.
This may be especially urgent now, with the public comment period still open on the proposed payment rule for 2023, and as policymakers debate whether COVID-related waivers and assistance should end.
Federal agencies, in particular, are considering critical decisions that would impact hospice care — sequestration of Medicare payments, continued access to expanded telehealth, and robust reimbursement for hospice care, among others.
Providers need to advocate for themselves to make sure they understand what’s at stake for providers and their patients, according to Jon Rawlson, government relations partner at the Nashville-based law firm Waller.
“I think hospice providers should always be on the front lines of having conversations with members of Congress about the impact of any kind of change in reimbursement methodology,” Rawlson told Hospice News. “It should encourage them to have regular home conversations in the district with congressmen and congressional staff. And I think the smaller the provider, the more important that conversation is.
These small providers often operate with very thin margins, which means that even small apparent changes in reimbursement could cause significant pain.
One example is Medicare sequestration, which cuts payments to hospices and other health care providers by 2% across the board.
Congress temporarily suspended this practice for much of the COVID-19 public health emergency, but the US Centers for Medicare & Medicaid Services (CMS) began reinstating sequestration beginning April 1. .
The agency will escrow 1% of payments until June, when the amount will revert to the usual 2%. Some providers have said the effects of this reinstatement could be “devastating”.
Advocates for the hospice space have repeatedly called on Congress to extend the moratorium or end the sequestration.
“Congress has found another $200 billion to spend on top of last year’s appropriations, but they’re ignoring the plight of hospices struggling to keep their doors open with soaring inflation and a shortage of healthcare workers. “, said Edo Banach, president and CEO of the National Hospice and Palliative Care Organization (NHPCO) and president of the Hospice Action Network (HAN), in a press release. “Again, our seniors and those with life-limiting illnesses have the short end of the stick.”
Although many believe the pandemic is coming to an end, the economic effects for providers will not disappear overnight.
Hospices continue to face rising costs for personal protective equipment (PPE) and COVID-19 test kits, paid staff leave and investments in telehealth. They also found a drop in institutional referrals and length of hospice stay.
Providers also face rising wages in a fiercely competitive job market, as well as price inflation that affects the entire country.
In January, the consumer price index rose 7.9% from a year earlier, according to the US Department of Labor, reaching a 40-year high.
Industry groups such as NHPCO regularly engage with policy makers, as do the National Association for Home Health & Hospice, the National Partnership for Hospice Innovation and the National Coalition for Hospice and Palliative Care, among others.
But more can happen at the local level, even for organizations that don’t have room for campaign giving in their budget.
This includes contributing to the proposed payment rates.
“My opinion is that there is a very good case for palliative care agencies to lobby the government to increase reimbursement rates,” said Carter Bakkum, senior data analyst for Health Care Information. at Trella Health, at Hospice News. “There is a massive argument that increasing the reimbursement rate for palliative care could reduce the costs associated with inpatient claims, skilled nursing claims.”
An increase in reimbursements could also partially alleviate the industry’s biggest headwind, labor shortages, especially in light of rising wages and intense competition for new hires, according to Bakkum. .
Some fear that unless workforce pressures are addressed, hospices will eventually run out of capacity to meet the growing demand for care.
“In order to do the highly emotional, highly scientific and technical work that they do, healthcare workers need to be paid very well,” Bakkum said. “For palliative care companies, one way to offset this in the short term is to secure funding either from private equity firms or government institutions.”
To date, federal legislation aimed at strengthening the hospice and palliative care workforce has repeatedly stalled.
For example, the Palliative Care Provider Training Act would allow members of the National Health Service Corps to defer service for a year to complete additional hospice care training.
A second bill, the Hospice and Palliative Care Education and Training Act (PCHETA) would provide funding for the training of doctors and nurses, among other interdisciplinary professions such as pharmacy, social work and chaplaincy.
Both have been introduced and reintroduced, but not adopted.
While agencies such as CMS regularly work with hospices; the same may not be true for many legislators or state officials.
To tell their story, providers will likely need to educate some government stakeholders about the benefits of palliative care and the challenges they face, just as they do other clinicians and the public.
In addition to letters and calls to legislative offices, hospices can comment on regulatory changes published in the Federal Register. For the proposed rule for 2023, the comment period ends on May 31.
Another beneficial strategy, according to Rawlson, is for a hospice to invite policy makers to tour their facilities or accompany staff on patient visits.
“It’s one of the best ways to educate and inform a congressman, let them see it in the field,” Rawlson said. “Members of Congress are aging. Their parents are aging. They may have family who have been through the hospice. You suddenly discover that you have struck a chord with a congressman who now understands palliative care better. »