FY2023 Hospice Wage Index Proposed Rule

Members were given a high-level recap of the FY2023 Hospice Wage Index proposed rule before diving into more detail on payment and quality issues. A full recap of the rule can be found here.

Regarding the proposal to cap negative wage adjustments to 5% a year, hospice members shared that their negative wage adjustments were typically less than 5%. Members also shared that they often serve multiple areas with different wage indexes that can shift year to year, creating greater instability in payments. Wage index decreases were not among the most significant factors impacting staffing troubles. Regarding staffing costs, many agencies have seen an increase in wage and benefits including workers compensation insurance costs. Members felt a survey of LeadingAge hospice members would be helpful to quantify costs, but it would be important to differentiate stand-alone providers from multi-site or network-based providers.

Members also discussed how inflation was impacting their agencies. Due to staffing shortages, many have seen their census numbers drop. At the same time, other fixed costs remained the same leading to increased agency costs overall. Other agencies shared that the lack of reimbursement to support telehealth remained a challenge. This has been a critical service during the pandemic to stretch already limited staff resources and stay connected to patients. However, many agencies do not have the capital to invest in these technologies without reimbursement. Members were asked to consider what types of measures and federal monitoring for waste, fraud, and abuse would be appropriate if telehealth were expanded for hospice with a payment mechanism. Providers shared concerns that as more people need care, but nursing shortages persist, high quality care will be more difficult to achieve since the current hospice model is heavily dependent on nurses. Hospices need more resources, not just telehealth, to support patients, like the ability to delegate to other staff.

In addition to the payment update, members discussed the request for information from CMS on health equity and the development of a structural measure to track health equity in hospice. Many members shared they are working to track health equity. Many have integrated health equity principles into recruitment practices including where they are posting job opportunities for all levels of staff including executives. Most members developed Diversity, Equity and Inclusion committees in their organizations as well as integrating the work into their strategic plans. There has been pushback from staff on certain health equity efforts that have been seen as political.

1135 Waiver Reversal

Earlier in April, CMS released a memo restoring certain minimum standards for compliance with hospice conditions of participation specific to inpatient hospice units which were waived during the COVID-19 Public Health Emergency (PHE).

During the PHE, CMS used the 1135 Waiver authority to offer flexibilities needed to respond to the pandemic for organizations, including hospices with physical inpatient units. CMS notes that states and individual facilities are still able to request regulatory waivers for flexibilities based on their unique facility or location, similar to situations like natural disasters.

The end of these specific blanket waivers does not impact other blanket waivers that remain in place until the end of PHE or until CMS otherwise terminates them. Providers are expected to take immediate steps to return to compliances within 60 days of CMS issuing this memo, or Monday, June 6, 2022. Additional information on these waivers is available here.

National Legislative Update and Regulatory Update

LeadingAge Leadership Summit: At the LeadingAge Leadership Summit in March, staff from Abt Associates, CMS’ contractor for hospice measurement developing, provided a presentation on the two new claims-based measures: Hospice Care Index (HCI) and Hospice Visits in the Last Days of Life (HVLDL). These two new measures will debut on the May 2022 Hospice Compare refresh.

Congressional Update: Congress was out of session during the week of the call. When Congress returns from recess, they will pick up issues including a mental health package.

Member Feedback

Hospice members requested time during the next meeting to get to know each other better given the diversity of membership. At the next meeting time will be set aside to do introductions and share information about each member’s hospice organization and their programs.