Medicare cuts for hospice care implemented over 7-year period, not 2
Hospices have more time to adjust to BNAF elimination
Choosing your battles wisely might be an essential rule for victory in war, but it also applies to efforts related to current health care reform proposals.
Members of the hospice industry chose to focus on the reimbursement hardship from reduction of the budget neutrality adjustment factor (BNAF), which is scheduled for implementation in October 2009, rather than the broader issues of health care reform, and it has paid off.
In the final rule, published Aug. 6 in the Federal Register, the elimination of the BNAF will be implemented over a seven-year period rather than the two-year period originally planned. Advocacy efforts throughout the hospice industry contributed to this change in the timeline to eliminate BNAF, according to the National Hospice and Palliative Care Organization (NHPCO) in Alexandria, VA.
"We have been advocating for reducing the BNAF cuts since they were first proposed," says Jonathan Keyserling, JD, vice president of public policy for NHPCO. A Capitol Hill Day in April 2009 and a Virtual Hill Day in July 2009 gave representatives from hospices an opportunity to let their legislators and public officials know how the proposed reduction of the BNAF and other proposed health care reforms would affect hospice agency's ability to serve patients.
Although stretching reduction of the BNAF over seven years brings some relief to hospice providers, threats still exist as provisions in health care reform legislation point to possible reductions in other areas of reimbursement, according to NHPCO. According to an evaluation of the proposed House bill by NHPCO, the cuts in reimbursement will amount to an approximate annual reduction of 3.2% for all health care providers. "The hospice industry's biggest concerns about health care reform are the financial implications," Keyserling admits.
One bright spot for hospice in the proposals being considered is that the hospice benefit remains the same, he reports. "This means that our legislative leaders recognize that hospice is working well and providing high-quality, cost-effective care," Keyserling says.
Because proposed health care reform rate cuts are across the board and will affect virtually every health care provider, they will be harder to fight, says Keyserling. The opportunity to initiate discussions with local legislators to discuss the effects of health care reform on hospice is one reason that Mary Anne Gorman, LMSW, ACSW, executive director of Harbor Hospice in Muskegon, MI, participated in NHPCO's spring Capitol Hill Day. As part of the day, Gorman and two other staff members from her hospice visited their legislators to discuss hospice and explain the implications of proposed legislation.
"Advocacy is something we do on a regular basis, in good times and bad, so it was natural to talk to our legislators and educate them," she adds.
The face-to-face meeting gave Gorman an opportunity to answer questions about how the 15% unemployment rate in Michigan affected people's ability to access hospice services and how the economic downturn has cut income from the agency's endowment fund. "Income from our endowment fund is used to fund charity care, so we are looking for other sources to fund care for people with no insurance and no other way to pay for hospice," she adds. A further reduction in reimbursement for Medicare patients would increase the pressure on the agency to find sources of income to cover uncovered services, Gorman says.
Advocacy efforts still important
Even with the relief that the time frame change for the BNAF elimination provides, it is important that the hospice industry continue to educate legislators as health care reform moves forward, says Keyserling.
"Rate cuts are the most critical issue that hospices face, and they are a key part of all health care reform proposals," he says.
In the House version of the health care reform bill, there is a second rate cut that is part of a proposed application of a productivity factor, says Keyserling. "If enacted, this could represent a 1% cut beginning in fiscal year 2010," he says. This cut is based on the assumption that as more health care providers adopt technology that improves productivity, they will cut costs of providing care, but it does not apply to hospice, Keyserling adds.
"Hospice is less reliant on information technology to improve productivity, and bricks-and-mortar-related expenses are not significant in the hospice industry," he says. "Hospice is a service-based model in which two-thirds of the expense is direct labor." For this reason, adopting new technology or reducing the number of physical locations are not options for hospice to reduce costs, he adds.
To make sure that legislators understand hospice and how certain requirements of health care reform will affect hospice differently from other types of providers, advocacy efforts need to continue, says Keyserling.
Carol Clark, director of volunteers for Casa de la Luz Hospice in Tucson, AZ, says, "Advocacy is a day-to-day job. Elected officials have a difficult job, and they want information that will help them understand the impact of their decisions."
Staying in touch with elected officials throughout the year in a positive, friendly manner makes it possible to contact them when tough issues need to be discussed, Clark says. "We let officials know when things are happening within hospice, and we let them know we're available to give them whatever information they need," she adds.
Don't forget to include media representatives as you share information, Clark suggests. Community forums at which local hospice representatives will speak to discuss issues in health care reform and what it means for hospice patients will be open to community members, but reporters will be invited as well, she says. "We have a good relationship with local media, and they call us regularly for information," Clark adds.
Advocacy at the individual hospice agency level differs from agency to agency, Gorman points out. "You have to advocate for hospice in ways that you feel comfortable, which means that some hospices may do more than others," she says. "Most importantly, you have to believe in your message so that it rings true." Whether your hospice has an intense advocacy effort or a limited effort, it all helps, Gorman says. "If we all do a little bit, we can accomplish a lot."
Need More Information?
Carol Clark, Director of Volunteers, Casa de la Luz Hospice, 400 W. Magee Road, Tucson, AZ 85704. Telephone: (520) 544-9890. Fax: (520) 544-9894. E-mail: [email protected].
Mary Anne Gorman, LMSW, ACSW, Executive Director, Harbor Hospice, 1050 W. Western Ave., Suite 400, Muskegon, MI 49441. Telephone: (231) 728-3442. Fax: (231) 726-2581. E-mail: [email protected].
Jonathan Keyserling, JD, Vice President of Public Policy, National Hospice and Palliative Care Organization, 1700 Diagonal Road, Suite 625, Alexandria, VA 22314. Telephone: (703) 837-1500. Fax: (703) 837-1233. E-mail: [email protected].
To see a copy of the final rule related to reduction of budget neutrality adjustment factor, go to www.gpoaccess.gov/fr. In the quick search box for "2009 (Volume 74) only" type: "Medicare Program; Hospice Wage Index for Fiscal Year 2010." Select the file labeled "fr06au09R Medicare Program; Hospice Wage Index for Fiscal Year 2010."
Choosing your battles wisely might be an essential rule for victory in war, but it also applies to efforts related to current health care reform proposals.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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