The Medicare Payment Advisory Commission (MedPAC) met on November 2 and discussed their hospice workplan for the coming 18-24 months. The plan consisted of four elements:

• Hospice’ effect on Medicare spending – MedPAC contracted with the Urban Institute to study the effect of hospice on Medicare spending. There will be a literature review and assessment of methodological approaches and challenges. It will also include a new data analysis with data through 2019 and including Part D spending. The results are expected in fall 2024.
• Effect of the hospice aggregate cap – MedPAC is conducting analyses of the cap’s impact on beneficiary outcomes – specifically looking at admission, discharge, and mortality patterns.
• Nonhospice spending for beneficiaries enrolled in hospice – MedPAC staff and a contractor conducted interviews with 12 hospices about factors contributing to nonhospice spending. The chapter on these interviews will be out in March. A preview of the findings aligned with LeadingAge’s comments to CMS – that there is lack of concrete CMS guidance on related vs unrelated services, there is variation in provider interpretation of the rules, and there are technological and logistical barriers to compliance.
• A new study on the intersection of hospice and ESRD.

The Commissioners were supportive of learning more about these topics via these workstreams though had a number of questions about the benefit itself.