Hospices seek solutions on non-cancer guidelines
Hospice leaders met recently with Tom Hoyer, director of the Office of Chronic Care and Insurance Policy at the Health Care Financing Administration (HCFA) to talk about local medical review policies (LMRPs), derived by Medicare fiscal intermediaries' (FIs) medical directors from the Arlington, VA-based National Hospice Organization's (NHO's) Medical Guidelines for Determining Prognosis in Selected Non-Cancer Diseases.
The non-cancer LMRPs have caused outcry among hospices, which argue that they are stricter and more rigid than NHO's original guidelines and pose a real danger of blocking access to hospice care for patients who are dying in less than six months but don't meet the letter of the policies.
Hospice advocates are seeking suspension of the LMRPs and the development of more flexible eligibility criteria. Hoyer urged hospices to find a way to work more closely with the FIs, which have a great deal of responsibility for the oversight of LMRPs, according to a report in the Hospice News Network, a publication of state hospice organizations.
Some hospice/home health FIs, including Health Care Services Corp. of Chicago and Palmetto Government Benefits Associates of Columbia, SC, have implemented the LMRPs. Others, such as Blue Cross of California in Woodland Hills, are working with providers through intermediary advisory committees to try to make them more workable. NHO staff and Brad Stuart, MD, chief author of the original NHO guidelines, have been participating in conference calls with the FIs' Carrier Medical Directors Committee. Changes have already resulted from these meetings for some non-cancer diagnoses.
"It's painful for everyone involved," observes Chris Cody, RN, NHO's director of professional and regulatory affairs. "I think we constantly have to monitor if people are getting denied coverage and, more importantly, are hospices turning away patients with non-cancer diagnoses?"
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