MEDPAC MAKES RECOMMENDATIONS TO CONGRESS FOR 2023 HOSPICE PAYMENTS

 

MedPAC’s January Meeting, held virtually on January 13 and 14, focused on recommendations to be made to Congress and the federal government on Medicare issues regarding 2023 payments. Kim Neuman, on 1/13, made the presentation “Assessing payment adequacy and updating payments: Hospice services.”

 

Neuman reported first on the use of hospice in frontier areas, noting that this segment of care has grown as quickly as urban hospice care since 2010. In 2020, there were 23,200 deaths of beneficiaries in frontier-area hospices. Of these, 7,700, or 33.3 percent, use hospice. To match rates of urban decedents, another 3,600 decedents would have used hospice. Frontier hospices must be monitored to understand the factors that create this lower use in frontier hospices.

 

In 2020, over 1.7 million beneficiaries utilized hospice—nearly half of all beneficiary decedents. This care was provided by over 5,000 hospices with total Medicare payments of $22.4 billion. The adequacy of payment for the services, according to Neuman’s report, is generally positive. Neuman reports an increase in provider supply, an increase in number of users, and a 2019 Medicare marginal profit of 17%. The quality of care for 2020 was difficult to assess, says the report.

 

There is a continued “entry” of for-profit hospices, because it is garnering positive attention of investors. The 2019 aggregate rates hospice margins at 13.4% and projects 2022 aggregate Medicare margin at 13%. In addressing the hospice aggregate cap, Neuman notes that the hospices most like to exceed the caps have long lengths of stay and high margins. In 2019, about 19% of hospices exceeded the cap. “Their Medicare aggregate margin was 22.5% before and 10% after return of cap overage.” Due to this, MedPAC recommended in March 2020 and 2021 that the “cap be wage adjusted and reduced 20%.”

 

The report notes that CMS has allowed hospice telehealth visits during COVID, and under certain circumstances. Hospices are not required, however, to report on these visits, except for those by social workers. With no data, MedPAC does not know the extent of use of hospice telehealth. “Requiring hospices to report telehealth visits would increase the program’s ability to monitor beneficiary access to care during the PHE.” The recommendations to Congress also called for the elimination of “the 2023 update to Medicare base payment rates for hospice providers.” (MedPAC, 1/13, https://www.medpac.gov/wp-content/uploads/2021/10/ASC_ESRD_Hospice_update-MedPAC-Jan22.pdf; AHA, 1/13, https://www.aha.org/news/headline/2022-01-13-medpac-votes-2023-payment-recommendations)

 

 

AUTHOR FOCUSES ON SHARED-DEATH EXPERIENCES

 

An article in Santa Barbara Independent offers an in-depth look into the life and work of William Peters. Peters is founder of the Shared Crossing Project and research initiative, which “studies extraordinary end-of-life experiences.” The Project focuses “on shared-death experiences, in which a loved one or caregiver is allowed to witness a dying person’s journey from this life into what lies beyond.”

 

Peters’ book, “Heaven’s Door: What Shared Journeys to the Afterlife Teach About Dying Well and Living Better,” is to be released on 1/22. The book shares “28 extraordinary personal stories about death and dying.”

 

Peters, a marriage and family therapist, did earlier work at the Zen Hospice Project in San Francisco. As a young adult, Peters had two near-death experiences himself. And, while working at the Zen Hospice he had an experience with a dying patient and floated “out of his body along with the spirit of a dying man while sitting with him.” He calls this experience a “divine gift.” Peters also worked with AIDS patients and heard stories about “shared-death experiences.” He  worked during two civil wars in Central and South America. So he has seen a lot of death.

 

After moving to Santa Barbara in 2009, “his practice increasingly dealt with grief from bereavement as a means toward psycho-spiritual growth.” He also heard a lecture by Raymond Moody, author of “Life After Life.” Peters then made a commitment to “explore the shared-death experience.” He started lecturing on end-of-life experiences. In 2011, he began his first group, called “Life Beyond Death.”

 

In the next four or five years, Peters did 12 such groups—and more than half of those who attended told of their own experiences around death and dying. Many of those who shared had never told their stories because of taboos about them. One hospice leader told Peters, “‘This is the secret of hospice. These things happen all the time, but we don’t talk about them.’”

 

The article shares a number of stories about personal experiences. In the book, the last story is about the death of Peter’s father. Overall, Peters longs to “end the silence around the shared-death experience. “‘If there’s anything you can’t argue with,” says Peters, “it’s in the data. I am an advocate for the normalization of these experiences and the inclusion of them in our end-of-life care and health care in general — across-the-board knowledge and preparation for them.’”

The first link below is for the article, and the second link is to the Shared Crossing Project’s website. (Santa Barbara Independent, 1/13, https://www.independent.com/2022/01/12/dying-well-at-heavens-door/; Shared Crossing, https://www.sharedcrossing.com/)

 

 

HOSPICE NOTES

 

* A recent article in Hospice News is titled “Pandemic Takes Heavy Toll on Hospice Bereavement Care.” The article examines the challenges that hospices face in order to maintain bereavement support. Many have turned to virtual settings to offer this care, and the article gives several hospices as examples of this change. (Hospice News, 1/13, https://hospicenews.com/2022/01/03/pandemic-takes-heavy-toll-on-hospice-bereavement-care/?euid=5366fb7d99&utm_source=hspn-newsletter&utm_medium=email&utm_campaign=1365ff6ca2)

 

* Empath Hospice has gotten permission by the state of Florida to expand their services into three additional counties. Empath will offer an “Empath Mobile Access to Care unit for outreach activities in rural and low-income areas, and a partnership with Heartland Rural Health Network. . .” (HomeCare, 1/12, https://www.homecaremag.com/news/empath-hospice-expand-florida)

 

* NHPCO responded positively to the Supreme Court decision to uphold the COVID vaccine mandate for healthcare providers in all states. The NHPCO press release says, “We supported and continue to support a vaccine mandate because we care about health care providers and the people and communities they serve. “(NHPCO, 1/13, https://www.nhpco.org/nhpco-comments-on-supreme-court-decision-on-vaccine-mandate-injunction/)

 

* Texas-based Choice Health at Home, LLC offers home health, hospice and rehab services Choice Health at Home, LLC acquired Kindful Hospice and A*Med Home Health and Hospice. With these acquisitions, Choice Health at Home, LLC gains Kindful’s six Oklahoma and Kansas locations and A*Med’s eight locations in Texas. Details about the acquisitions are online at the link below. (Digital Journal, 1/14, https://www.digitaljournal.com/pr/choice-health-at-home-closes-new-190m-credit-facility-in-connection-with-multiple-acquisitions)

 

* The Care Team (TCT) provides hospice and home health in Michigan, Pennsylvania and Texas. TCT has now acquired Texas-based Crossroads Hospice. (El Paso Inc, 1/13, http://www.elpasoinc.com/news/state/revelstokes-the-care-team-acquires-crossroads-hospice/article_81a76572-6eb2-5ca9-be10-f95968a12d97.html)

 

 

END-OF-LIFE NOTES

 

* Massachusetts legislators are again considering aid-in-dying. An article in Massachusetts’s MetroWest Daily News says that, according to a 2020 poll, 70% of Massachusetts’ citizens support medical-aid-in-dying. And 74% indicate that, if they were dying and in awful pain, they would want medical treatment to end. Several attempts to introduce the law have failed in past years, and the state remains divided over the issue. (MetroWest Daily News, 1/7, https://www.metrowestdailynews.com/story/news/2022/01/07/massachusetts-divided-over-concept-medical-aid-dying/9084636002/)

 

* End of Life University shares a podcast on “Swedish ‘Death Cleaning.’” Karen Wyatt leads the podcast and says the practice is something we “could be teaching our patients and clients along with educating them about advance directives.” (End of Life University, 1/10,

https://eolupodcast.com/2022/01/10/ep-333-swedish-death-cleaning-the-perfect-way-to-begin-a-new-year-with-karen-wyatt/?mc_cid=e7c8d74e8c&mc_eid=d0771da91c)

 

OTHER NOTES

 

* An article in Inc. explores “5 Covid-Driven A.I. Trends That Are Changing Health Care.” A.I. now has stethoscopes that can send heart and lung sounds directly to a healthcare provider during a virtual visit. A.I. can enable patients to conduct some lab tests at home. Time in imaging machines can be reduced significantly with A.I. Patients with smartphone are able to get feedback on exercises and posture. And certain uses of A.I. can reduce “need or frequency for in-person follow-ups.” Contactless in-home monitoring systems can track sleep and restoration. (Inc., https://www.inc.com/melissa-angell/artificial-intelligence-driving-health-trends-coronavirus-healthcare.html)

Hospice Analytics is the national sponsor of Hospice News Network for 2022. Hospice Analytics is an information-sharing research organization whose mission is to improve hospice utilization and access to quality end-of- life care. For additional information, please call Dr. Cordt Kassner, CEO, at 719-209-1237 or see www.HospiceAnalytics.com.

 

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