Unlimited - lacking any controls: unrestricted <unlimited access>; boundless, infinite <unlimited possibilities>
In the wake of recent CMS and the OIG actions focused on tightening eligibility criteria for hospice as a means to save Medicare costs, CMS is also soliciting proposals for Round 2 of their Health Care Innovation Awards.
The connection between these two actions may not be obvious, until we listened to a CMS Webinar regarding the types of proposals they are seeking. Under Category 1 - Models that are designed to rapidly reduce Medicare, Medicaid, and/or CHIP costs in outpatient and/or post-acute settings – CMS specifically stated during the Webinar that proposals designed to reduce hospice spending were being sought.
Which makes us wonder – is CMS seeking to further limit access to hospice care or are they seeking ways to change the payment structure (a major focus of the Funding Opportunity Announcement) and could it actually lead to greater access to hospice?
The stated goal of this round of funding is to “propose new payment and service delivery models that will provide better health, better health care, and lower costs through improved quality.” So conceivably, if a model was developed that delivered high quality care at a lower cost to patients earlier in their disease process, it could, in fact, expand access to care AND reduce Medicare spending. A win, win, win for Medicare, patients/families and hospices.
If one or more hospice models is selected by CMS for implementation, the results will likely be years down the line. However, if one or more models expanding access to hospice is well developed and implemented and results in cost savings, these days of rate cuts and efforts to limit eligibility to hospice could be just a bad memory.
Unlimited access to hospice is probably unrealistic. However, loosening restrictions is a goal worth working towards.
Kathy Brandt, MS, Principal, the kb group
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