Lawsuit challenges Medicare cuts for Hospice

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From the Advance for Nurses: ADVANCE for Nurses | National News

The National Hospice and Palliative Care Organization (NHPCO) has filed a lawsuit to stop a Centers for Medicare and Medicaid Services' (CMS) rule that would cut Medicare reimbursement rates for hospice and would irreparably damage hospice programs across the country.

The Bush Administration proposal, if enacted, would have a direct, negative impact on care at the bedside for the nation's most vulnerable populations. The rule was published in The Federal Register on Aug. 1, and is effective Oct.1.

"The administration's rule is arbitrary and capricious," said NHPCO President and CEO J. Donald Schumacher. "It will force many hospice providers across the country to either significantly scale back the care they provide to terminally ill patients or to shut their doors altogether."

The lawsuit, filed in U.S. District Court for the District of Columbia, requests an immediate injunction to prevent the rule from becoming effective.

On April 28, CMS acted on a provision in the President Bush's Fiscal Year 2009 budget proposal that would cut hospice reimbursement rates, altering the wage index adjustment by phasing out the budget neutrality adjustment factor (BNAF) that was applied to the hospice wage index in 1997 to minimize the disruption in beneficiary access to hospice services.
If implemented, such a reduction would cut hospice reimbursement by almost $2.2 billion. Average hospice reimbursement would be reduced from current levels by more than 4 percent.

"The rule is an effort by CMS to reduce hospice payments by regulation but does so without enough data to back up its push to cut hospice care to the terminally ill," noted Jonathan Keyserling, executive director of the Alliance for Care at the End of Life.

In creating this rule, CMS failed to analyze whether and to what extent the BNAF has played in the growth in the number of hospices or in hospice expenditures since the hospice wage index was established in 1997. CMS also failed to analyze the effect of eliminating this component of the hospice wage on hospices and Medicare beneficiaries in need of hospice care.

"NHPCO filed suit because the proposed changes to hospice care of this type and magnitude require substantive supporting evidence, which we do not find in this rule," said Keyserling.

Hospice a Cost-Effective Choice

Independent research has shown hospice saves the Medicare system money. According to an independent 2007 Duke University study, hospice saves Medicare an average of $2,300 per patient, amounting to a total savings of about $2 billion a year. Research has also shown hospice care is highly rated by family members of hospice patients, and enables the patient to die at home in most cases.

Congress has historically rejected Bush Administration requests to reduce the level of hospice reimbursement, realizing the harmful impact such cuts would have on care at the bedside. "And this time is no different, someone needs to speak up for our nation's most vulnerable population, the dying and their families" says Keyserling. "Congress should intervene to stop the administration's cut to hospice care, before the rule goes into effect."

Considered to be the model for high-quality care for terminally ill patients, hospice focuses on caring, not curing, and, in most cases, is provided in the patient's home.

Hospice professionals are experts in providing pain and symptom management to the dying. More than 1.3 million dying Americans received care from the nation's hospice providers last year, a number that continues to rise.

NHPCO is the oldest and largest nonprofit membership organization representing hospice and palliative care programs and professionals in the U.S. For more information visit
http://www.nhpco.org/

The Alliance for Care at the End of Life, a 501(c)4 organization, was created by the National Hospice and Palliative Care Organization (NHPCO) in April of 2007 to provide a more aggressive and comprehensive advocacy voice that will serve the entire field and, ultimately, one of America's most vulnerable populations - those nearing the end of life.
For more information, visit http://www.afceol.org/