Exploring the Final Rule for Value Based Measurement for Hospice Agencies

Effective October 1, 2021, the Centers for Medicare and Medicaid Services (CMS) enacted a final rule regarding updated terms for hospice agencies. In addition to outlining annual caps, several new changes were unveiled that hospice agencies must follow in order to receive full reimbursement on their claims. All providers that are certified to collect Medicare claims must comply with HIS and CAHPS requirements, otherwise they will not receive full payout. Below, we will discuss the most sweeping changes that were released by this new final rule, and you can find documentation from the CMS at the end of this section for further review. 

Annual Rate Increases 

As part of the new final rule, the CMS outlined an increase in payment caps for enrolled patients - up to $31,297.61 in 2022 from $30,683.93 in the previous year. Hospices will see a 2.0 increase in payments (which equates to $480 million) which is a combination of a 2.7 percentage point increase based on the market and an adjustment of 0.7 for productivity. 

Hospice Care Index: Care Quality Subject to Evaluation by 4 Measures 

One of the most significant changes that was enacted under the new final rule is the quality evaluation that will be administered based on 4 different measurements to determine overall quality of care. The Hospice Quality Reporting Program (HQRP) will utilize the hospice care index, with 4 specific measures including 10 indicators of quality that are calculated to determine payouts rendered based on claims. According to the CMS, “Collectively, the indicators represent different aspects of hospice care and provide a comprehensive characterization of the quality of care furnished by a hospice throughout the stay.” The claims-based measure will be reported to the public by May 2022. 

Fast Healthcare Interoperability Resources 

The CMS’s mission is to improve quality of care and life for patients undergoing hospice care, and in their continued effort, they are prioritizing transparency, reporting, and measurement. The FHIR (Fast Healthcare Interoperability Resources) will make it simpler for providers to digitally submit the information on their patients so that it can be used in many different ways to quantify and measure the quality of care the patient is receiving. CMS is also focused on making a continued effort to promote equity in healthcare and addressing common challenges that lead to unequal care in hospice agencies. 

See the final rule at: https://www.cms.gov/newsroom/fact-sheets/fiscal-year-fy-2022-hospice-payment-rate-update-final-rule-cms-1754-f