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NHPCO Statement on MedPAC Recommendations to Congress
Date:2/27/2009

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"Guiding this review ought to be several clear principles. Among them are:

  • Advancing hospice and palliative care programs as the recognized providers of end-of-life care;
  • Preserving and enhancing the Medicare hospice benefit;
  • Recognizing "high quality" as the standard to which all providers must subscribe;
  • Ensuring accountability through transparency and fair regulatory scrutiny; and
  • Promoting increased access through expansion and collaboration.

"Payment policy is one of the areas of the Medicare hospice benefit that needs to stay current, so that payment appropriately recognizes changes on patient demographics and treatment protocols. Updates should be carefully considered and evidence-based to ensure that behavioral consequences are understood prior to implementation. The present payment methodology has served the hospice community and the public well since its inception, virtually without change. Analysis of both current and historical patient level data is necessary to fully understand and predict future behavior and needs, and make changes that continue to provide benefits to patients and to the Medicare system.

"As with any payment system, dramatic changes to the hospice benefit from established patterns of reimbursement are sure to produce displacements and unintended negative consequences. Given the nature of hospice referrals and the unique characteristics of the end-of-life patient demographics, unintended consequences of such changes are inherently difficult to predict. Any number of issues might warrant attention, but effectively quantifying such items in terms of behavior changes of patients and providers would be difficult. Payment reforms should be incremental, based on adequate data analysis, and need to be undertaken carefully, with effects on the patient and family in mind.

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SOURCE National Hospice and Palliative Care Organization
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