The Government Accountability Office (GAO) is proposing that Congress consider changes to the way Medicare pays for hospice routine home care based on a comparison of payment mechanisms between home health and hospice – though some industry groups caution that the GAO’s recommendation oversimplifies key differences between hospice and home health.
GAO said Medicare could have saved about $7.6 billion if hospice routine home care from 2022 through 2024 had been reimbursed using adjusted home health per-visit rates rather than hospice’s current per-day payment system, according to a GAO report released Tuesday.
The report found that Medicare paid about $16.7 billion for hospice routine home careamong the beneficiaries included in its analysis, compared with an estimated $9.1 billion under a home health-style per-visit payment system.
GAO found that “low-visit” hospices received substantially higher effective payments per visit than high-visit hospices under the current payment structure. “Low visit” hospices are concentrated in known high-fraud areas, according to the National Alliance for Care at Home (the Alliance). The Alliance recommended that hospice reform should focus first on fighting fraudulent activity, which it said would result in greater savings than those outlined by the GAO.
The Alliance also contended that hospice is a comprehensive benefit and requires a different payment approach.
“The GAO report also fails to recognize the distinct differences between the home health and hospice benefit structures, regulatory requirements, and skillsets needed to deliver care,” the Alliance’s statement read. “The hospice daily payment rate is a deliberate design that reflects the nature of hospice care. Unlike home health, hospice is a holistic, comprehensive benefit that includes all services needed for the palliation and management of a patient’s terminal condition.”
While the Alliance questioned the GAO’s comparison of hospice to home health, Mollie Gurian, vice president of policy and government affairs for LeadingAge, said that the comparison could be a helpful tool.
“Their attempt to look at a per-visit [payment by] starting with home health, and then trying to add in some of the things that home health doesn’t cover, is probably going to be a helpful starting point for us to make it less theoretical,” Gurian told Home Health Care News’ sister publication, Hospice News.
Gurian said that the GAO did not attempt to compare the entire home health payment system to the entire hospice payment system, and made adjustments to its model to attempt to make it a more “apples to apples” comparison.
LeadingAge members are likely to find flaws in the comparison, Gurian said, and are likely to respond to the recommendation by attesting that home health payments themselves are insufficient. The report could prompt additional questions about the home health rate, such as if travel time is appropriately accounted for.
Jim Parker, Senior Editor of Hospice News, contributed reporting to this article.