The Long Run: Hospice Payment Suspensions May Cost Medicare More Money

Photo credit: Geralt

Ahoy!

We at WTWH Healthcare, Hospice News’ parent company, had a large in-person meeting this week. We have all worked remotely since the pandemic, so it was great to see and reconnect with some of my favorite colleagues – and it was gratifying to be able to share how much growth and engagement we’ve had on Inside Hospice since launching just a few months ago. So, thank you all for reading, commenting and supporting this endeavor!

Today, I want to talk a little bit more about the recent rash of hospice Medicare payment suspensions.

Some stakeholders in the hospice space posit that recent payment suspensions on hospice providers by the U.S. Centers for Medicare and Medicaid Services could drive up health care costs by moving more patients out of hospice and into the hospital system.

I’ve reported extensively on the payment suspensions and the way that legitimate providers are being swept up in this crackdown, both on this site and on Hospice News, and more stories on this are on the way. Check out the linked stories for more context.

One of the major concerns associated with this is continuity of care. When a hospice isn’t getting paid or can’t sustain operations, what happens to their patients?

According to the conversations I have had with about 13 affected providers, these are some of the common outcomes:

• The patient is transferred to another hospice

• The patient stays on the original hospice’s census, but the provider stops accepting new patients

• The patient is discharged alive and does not receive further hospice care before they expire

CMS is trying to cut down the economic cost of fraud in the space, though some may question whether these suspensions – and the methodology behind them – is the right approach. However, some contend that the agency’s “sledgehammer” approach to fighting fraud could ultimately cost Medicare more money. The prospect that at least some of these patients wind up in the hospital or in an emergency department visit seems very probable.

We know that hospice reduces higher acuity care and saves the system a substantial amount of funds. I cited some of the data in another Inside Hospice post just the other day, so I don’t think I need to repeat it all here. In the absence of hospice, or if patient care is delayed due to a transfer, patients have few other places to turn than hospitals, according to one hospice CEO who spoke to me on background.

“After you discharge them, they may have to be readmitted multiple times. What’s the purpose of having Medicare pay $5,000 a day for multiple readmissions in the hospital?” the CEO said. “Why not let me pay $220 to a hospice and let them take care of them at home? That’s a huge cost savings.”

I think this is food for thought. It would be helpful to see some research into this to get some data on what happens to patients after these suspensions, but for now unanswered questions persist.

Also, I would like to point out one of Substack’s other features – Notes. There are short, separate posts that I have been using to pose questions to you, my readers. I get no responses. I think because the site doesn’t notify readers when one is posted.

This is my most recent note, with a question about the HOPE tool. I would love to hear your feedback on this. To find past posts of this kind, please click on the “Notes” tab at the top of the home page. Thanks for taking a look!