Pay Bump for Hospice on the Horizon
CMS looks to slightly increase Medicare hospice payments for 2027
By Michelle Love
The Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule that would increase Medicare hospice payments by 2.4% in fiscal year 2027 and also create a new public scoring system for hospices.
BY THE NUMBERS
That rate would total an estimated increase of $785 million in payments compared to fiscal year 2026, and results from a proposed 3.2% market basket percentage increase minus a proposed 0.8% productivity adjustment. Hospices that don't submit required quality data would see rates reduced by four percentage points, or a 1.6% reduction over this year’s payment rate.
MILLION
NEW SCORING SYSTEM
In the “Fiscal Year 2027 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Program Requirements Proposed Rule,” CMS is also unveiling a new, publicly available hospice scoring system based on indicators of potential inappropriate utilization, quality of care and compliance concerns. The system would publish a number score online for hospices, with lower numbers being lower risk and those with high scores potentially open to further review.
CMS said the scoring system would increase transparency and ensure Medicare hospice benefits are not abused by fraudulent actors. The scoring system, titled the service and spending variation index (SSVI), will assign hospices a score based on a variety of metrics CMS gathers from hospice claims, including:
- Non-hospice spending
- Percent of beneficiaries discharged with a length of stay of 180 days or more
- Average minutes per routine home care day
- Percent of live discharges where beneficiaries return to the same hospice in seven days, among others
CMS said these metrics were chosen to compare spending and care delivery between hospices, and while this information is not a direct indicator of fraud, waste or abuse, a high SSVI score would represent a potential higher level of concern, as this may signal potential program integrity risks or inappropriate utilization.
The rule also proposes a new icon be added to the medicare.gov compare tool that will identify hospices that submit no data or less than the required 90% of quality data,
→WHAT HAPPENS NEXT: Comments on the proposed rule are due June 1.
INDUSTRY RESPONSES:
“Hospice care is an invaluable part of the Medicare program, with evidence demonstrating that it is the preferred choice by patients and families when appropriate. While a 2.4% payment increase is a step in the right direction, more must be done to ensure that high-quality providers have the resources they need to operate in this demanding environment.” — Jennifer Sheets, CEO, National Alliance for Care at Home
"Given today's uncertain economic environment, and the increased costs in critical categories including food, energy and wages, the modest 2.4% proposed payment rate boost … is cause for concern." —Linda Couch, Senior Vice President of Policy, LeadingAge
"(The National Partnership for Healthcare and Hospice Innovation, or NPHI) urges CMS to implement a temporary, nationwide moratorium on new hospice provider enrollments in response to the continued growth of fraudulent providers in the hospice community. These bad actors exploit vulnerable patients, undermine trust, and threaten the integrity of the Medicare hospice benefit." —Tom Koutsoumpas, Founder and CEO, NPHI
Michelle Love is associate editor for HomeCare Media.
Namiuchi Beroko-AdobeStock.com
