Hospice HELP Act of 2013

Some quick thoughts on the “Hospice Evaluation and Legitimate Payment Act of 2013” the so-called HELP hospice Act (h/t for the text to @HospiceAction).

  • It is co-sponsored by a Democratic Senator (Ron Wyden of Oregon), and a Republican (Pat Roberts of Kansas). Until the unhinged and fact free death panel rants of August 2009 and continuing, the hospice movement enjoyed bipartisan support, I think because everyone eventually dies and it is in everyone’s self interest to improve the options of those who are acutely facing death. That bipartisanship has been on hiatus since the passage of the ACA. For example, the word palliative care does not appear in the ACO regulations, and the word hospice appears only once. However, these are both crucial in any attempt to deliver care to a defined population of elders with the goal of increasing quality of life/value of care while addressing costs. If the HELP hospice Act goes forward, it will show we have been able to get back to some policy in this general area.
  • The bill proposes a modification of the face-to-face encounter re-certification provisions in hospice when a patient uses hospice beyond the first 60 day eligibility period. The big picture is worries about increasingly long stays among long stayers as outlined by MEDPAC. The goal is to right-size the regulation and not make it too burdensome, while making sure use is appropriate.
  • Proposes a hospice payment demonstration to replace the 30 year old per diem payment approach.  This would delay the Secretary of HHS’s ability to bring about a new hospice payment system (which cannot be done before October 1, 2013 under the auspices of the ACA), but with the HELP hospice bill it could not be done until October 1, 2017, after the proposed demonstration. Most of the bill details how this demonstration should be done (include at least 15 representative hospice providers, have an evaluation and report, the 2 year demonstration must be budget neutral). Note, this is not the same 15 hospice demonstration that was enabled by the ACA for testing concurrent care, but that has not been funded. However, I read the language of the HELP hospice Act to be broad enough to encompass this concurrent idea.
  • Sets up a regular survey requirement for hospice providers by a local of State accreditation agency once every 36 months.

Hospice policy questions used to be dealt with in a bipartisan fashion. It will be interesting to see if we have gotten back to the point at which we can have any health policy legislation move ahead in its own right, and not simply become the next volley in the ongoing meta health policy wars. The hospice tag of this blog will get you much more info on this area if you want it.

About Don Taylor
Professor of Public Policy at Duke University (with appointments in Business, Nursing, Community and Family Medicine, and the Duke Clinical Research Institute). I am one of the founding faculty of the Margolis Center for Health Policy, and currently serve as Chair of Duke's University Priorities Committee (UPC). My research focuses on improving care for persons who are dying, and I am co-PI of a CMMI award in Community Based Palliative Care. I teach both undergrads and grad students at Duke. On twitter @donaldhtaylorjr

One Response to Hospice HELP Act of 2013

  1. Pingback: Care Planning Act of 2013 | freeforall

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