Ask Congress to Reject Efforts to Reduce the Hospice Aggregate Cap in an End-of-Year Bill!

In early 2020, the Medicare Payment Advisory Commission (MedPAC) approved a recommendation that Congress enact legislation to wage adjust the hospice aggregate cap (the "cap") and cut it's value across-the-board by 20%. MedPAC provided no analysis supporting the appropriateness of the cap cut except that it would change financial incentives and potentially reduce long lengths of stay on the benefit. MedPAC estimates that the number of hospices that exceed the cap would roughly double as the result of these changes. As Congress is negotiating a year-end omnibus legislative package, there is a threat they may consider cutting the cap to pay for other, non-hospice issues, such as reducing scheduled cuts to physicians or extended telehealth provisions.
Cutting The Cap By 20% Will Make It Harder For Some Of The Most Vulnerable Patients To Get Hospice

While the recommendation is an attempt by MedPAC to address outlier hospice program utilization, this overly blunt proposal is problematic for a number of reasons, including:

Patient access to care could be significantly reduced: a 20% cap cut would create disincentives to serve patients that have a more unpredictable disease trajectory, such as those with dementia and organ failure, thereby disenfranchising entire categories of patients’ access to the hospice benefit.
It could further exacerbate health disparities in hospice access and utilization: The individuals most likely to have their access to hospice impacted by the cap reduction (those with dementia and other neurological diagnoses) are also more likely to be from medically underserved communities that already have lower rates of hospice utilization.
It may result in increased overall spending by Medicare: Any proposal that could limit hospice use, such as the cap reduction, may result in increased overall spending for Medicare, as patients who might have been served by cost-saving hospice instead utilize more expensive and aggressive care such as hospital, ER, and skilled nursing facility services. Recent research has shown that hospice use by Medicare beneficiaries is associated with significantly lower total health care costs across all payers, including Medicare.
A deep cut to the hospice cap is a crude tool to change hospice financial incentives and fails to take into consideration the many factors that contribute to variations in patient care needs. These factors include a more complex patient population for whom establishing an accurate six-month prognosis can be challenging, as well as greater variation in overall patient mix.
Congress must NOT enact major hospice policy changes such as a cap cut in a rushed and unfocused way in the sprint towards a end-of-year omnibus bill, especially as there have been no congressional hearings or public review of the implications of this policy on patient access.  

Reject Proposed Cuts to Hospice Aggregate Cap FACT SHEET


Ask Congress to Reject Efforts to Reduce the Hospice Aggregate Cap in an End-of-Year Bill!


On behalf of the National Association for Home Care and Hospice, Thank you for supporting the hospice communities. 

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