The US Centers for Medicare & Medicaid Services (CMS) released the 2023 proposal on Wednesday payment rule for palliative care providers, including a 2.7% increase in per diem rates. The rule also contains a template for phasing in changes to how CMS will use the Salary Index to inform payout rates in future years.
Through the wage index phase-in plan, the agency is changing the data sources it uses to adjust hospice payment amounts to account for differences in wage rates between markets. The implementation strategy is designed to minimize disruption as well as monetary impact on vendors.
“This proposed rule provides a permanent, budget-neutral approach to smooth year-over-year changes in the Hospice Care Salary Index,” the agency said in a statement. “Specifically, we are proposing a permanent cap on negative changes in the wage index greater than a 5% decrease from the previous year (regardless of the underlying reason for the decrease) for hospices in the proposed rule for fiscal year 2023.”
The salary increase comes at a time when the financial resources of palliative care providers continue to be strained by expenses associated with the COVID-19 pandemic, as well as price and wage inflation. Operators also face labor pressures and reduced patient length of stay.
If finalized as written, the rule would also increase the aggregate payout cap to $32,142, a corresponding 2.7% increase from $31,297.61 in 2022.
Additionally, the proposed rule kicks off a web-based methodology for the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey, which has historically been paper-based.
More and more patients and families are using this information when choosing a hospice. Likewise, referral organizations such as hospitals, primary care physicians, and nursing homes use the data to guide referral and contract decisions.
CAHPS data is incorporated into the CMS Palliative Care Star Ratings in 2022, in accordance with the proposed rule.
The proposal also includes an update on the agency’s testing of the Hospice Outcomes & Patient Evaluation (HOPE) tool. The will replace the Hospice Item Set (HIS) Quality Reporting System when completed.
Unlike the HIS system which extracts data from a set of elements of a patient’s medical record using a standardized mechanism, the HOPE tool will measure aspects of palliative care at different points in the patient’s experience. patient.
“HOPE is an ongoing patient assessment instrument designed to capture patient and family care needs throughout the hospice stay,” CMS said in the rule. “HOPE supports care planning, quality improvement efforts, and the health and safety of patients enrolled in Medicare-certified hospices.”