Health Care Reform Can Improve Quality Care for Hospice Patients
Posted: January 21, 2013
The Patient Protection and Affordable Care Act (ACA) that was signed into law in March of 2010, and upheld by the U.S. Supreme Court last year, is designed to reform the nation’s health care system to improve access to quality health care for Americans while controlling costs. As Barack Obama is sworn into office for a second term, our 44th president is determined to see health care reform through, while the debate carries on.
As the largest generation of baby boomers began turning 65 in 2011, this population will continue to grow as an estimated 8,000 Americans reach retirement age every day from now until 2029. Many of those same baby boomers, who are also moving into the Medicare program, will someday seek hospice care.
According to the National Hospice and Palliative Care Organization (NHPCO), more than 1.6 million patients were served by hospice organizations in 2011, compared to only 25,000 in 1982. With an aging population, the number of Americans opting for hospice care will continue to rise.
The hospice community has been subject to several regulatory and legislative changes in recent years – changes that should improve quality of care, yet make care more challenging because of reimbursement reductions. A 2009 rule from the Center for Medicare and Medicaid Services initiated a permanent reduction in hospice reimbursement rates of approximately 4.2 percent. The ACA further abridged the Medicare hospice rate through the introduction of a productivity adjustment factor that will reduce annual hospice payments by an additional 11.8 percent over the next ten years.
Although the productivity adjustment factor poses a risk of reimbursement reduction, it requires hospices to report quality measures. Beginning in 2014, hospice agencies will have to report every patient’s comfort level (pain management) and select at least one other quality indicator to report, such as the number of patients with shortness of breath who improved within one day of assessment or the number of falls.
Hospice providers that do not comply with the ACA-mandated quality reporting system will face additional reductions in Medicare reimbursement. While decreased funding will unfortunately cause some hospice organizations to decrease services or worse, discontinue all services entirely, those that do comply will provide improved comfort care. Patients and family members will have access to hospice quality data, and hospice providers failing to meet benchmarks will be forced to improve quality of care or lose patients.
For hospice patients and their family members, there is tremendous peace of mind in knowing that the hospice organization they have entrusted is able to quickly identify and manage the patient’s comfort level, not only physical, but psychological and spiritual as well.
Although all hospice agencies are not required to begin quality reporting until 2014, hospice agencies could have participated in voluntary reporting this year. Participating hospices can already tell patients and families how well they control patients’ pain and symptoms so families can make informed hospice selections. Patients and families should also be asking hospice organizations what their nurse to patient and social worker to patient ratios are, whether the hospice is accredited by a national organization, and how the agency provides services after hours to ensure their loved one receives proper attention and care.
In the coming months, hospices face additional reimbursement uncertainty. Congress must reach an agreement on spending cuts, and by no means is it a certainty that hospices and other Medicare providers will be spared from cuts.
Regardless of what may lie ahead, Arbor Hospice will continue to place patients and families first, and find a way, with the support of its board, staff, volunteers and community members, to meet the end of life needs of the communities we serve.
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