President Trump’s FY 2019 Budget Proposal

On Monday, President Trump released a 4.4 trillion dollar FY 2019 budget proposal.  While the budget would boost military spending and increase border security, it would provide major cuts to many domestic programs. For the healthcare community , the proposal calls for billions of dollars in savings through changes in Medicare and Medicaid and a boost in health spending to combat opioid abuse and mental health and drug-related issues.

Although Trump pledged not to interfere with the Medicare entitlement program, his plan would expand Medicare’s policy on site-neutral payments, in which providers would be paid equally regardless of where they deliver care, saving taxpayers an estimated $80 billion over a decade.  Another $34 billion would be saved by paying independent practices the same as hospital-owned doctor practices.  On Medicaid, Trump intends to rescind Obamacare’s expansion, instead providing block grant funding to states.  The proposal would make it easier for states to move toward managed care, increase co-payments for emergency room visits, and reinforce requirements that Medicaid recipients show immigration status before enrolling.

President Trump’s budget proposes $10 billion in discretionary funding for the Health and Human Services Department (HHS) to combat America’s opioid crisis and assist in programs geared toward curbing drug abuse and mental health related issues.  This is an effort to expand drug abuse prevention, treatment and recovery programs and give HHS more opportunity to direct resources toward this growing issue.  The budget also seeks to crack down on high-opioid prescribers and utilizers in Medicaid and would require plans to participate in a program to prevent prescription drug abuse in Medicare Part B.  Furthermore, while many states are tackling the opioid issue with more stringent prescribing and disposal laws, many of these laws include exemptions for prescribers treating patients under hospice care. NHPCO believes that these exemptions recognize the sensitivity and vulnerability of those suffering advanced illness and at the end of life, and accommodate their needs. It is crucial that these exemptions are preserved and further efforts to reduce opioid prescribing do not unintentionally decrease the ability of hospice and palliative care providers to manage their patients’ pain needs effectively.

NHPCO will closely track this proposal and weigh in with policymakers to ensure that the interests of the hospice and palliative care community are protected.

GREAT NEWS – Medicare Extenders Update!

As you may know, yesterday the Senate reached an agreement on a package of budget and Medicare bills known as the Medicare Extenders.  The legislation is expected to pass both the Senate and the House and be signed by President Trump later this week.  The bill included several provisions of interest to the hospice community.

The great news is that the legislation includes The Medicare Patient Access to Hospice Act, which would allow physician assistants (PAs) to serve as the attending physician to hospice patients and perform other functions that are otherwise consistent with their scope of practice.  Currently, Medicare only allows physicians and nurse practitioners to serve as the hospice attending physician, despite the fact that there is a shortage of hospice providers in rural and underserved communities.  Often times, people in these communities receive primary care from a PA prior to their hospice election and must give up that provider when they elect hospice.  This common sense, bipartisan legislation will go a long way to ensuring that patients can have their preferred care team at the end of life. NHPCO strongly supported this important legislation and applauds Congress for its inclusion in the Medicare/budget package.

Another positive development is a requirement for the General Accountability Office to study and report on longitudinal comprehensive care planning services under Medicare Part B. This study – due 18 months after enactment – could help inform the development of a payment code describing the formulation of a comprehensive plan of longitudinal care for a Medicare beneficiary diagnosed with a serious or life-threatening illness.

The legislation also includes a provision that reduces payments to hospitals upon certain discharges to hospice.  NHPCO closely monitored this legislation, as there is some concern that hospitals could delay hospice referral to recoup their entire DRG patient. To better assess the overall impact, Congress also mandated that the Medicare Payment Advisory Committee (MedPAC) evaluate this change to determine its effect on hospital-hospice transfers, hospice length of stay, and overall spending. The budget deal did not include the Rural Access to Hospice Act, but NHPCO will continue to push for enactment of that bill later this year.

So as we continue to push for support of the Rural Access to Hospice Act, let’s also take a moment to celebrate this phenomenal victory for the hospice community and share the news with our constituents!

As usual, we will continue to keep you updated on any legislative changes and we need YOU to continue to advocate for quality, end of life care.


An NHPCO Podcast Special Feature: Policy Outlook 2018

NHPCO President and CEO Edo Banach talks with Vice President of Health Policy Sharon Pearce about the policy outlook in Washington, right now and for the future. From a possible government shut down to extenders that may be attached to Medicare legislation in Congress right now, Edo and Sharon offer some thoughts that might be helpful to the hospice and palliative care community. They acknowledge change can happen quickly and it’s important for all hospice advocates to keep informed. Listen to the podcast now!


NHPCO Quality Alerts ICYMI: Recent Updates on Quality Measurement and Hospice Compare

In case you missed it, NHPCO’s Quality Team recently provided important information on updates related to the Hospice Quality Reporting User Manual and the Hospice Compare resource.

First, the Hospice Quality Reporting User Manual has been updated to include measure specifications for the Hospice and Palliative Care Composite Process Measure: Comprehensive Assessment at Admission (NQF #3235).

Also, CMS has changed the process for requesting corrections and updates to hospice provider demographic information in Hospice Compare.  Hospice Providers must now contact their Medicare Administrative Contractor (MAC) for assistance if they find inaccurate data included on their Preview Report or on the Hospice Compare website.  For more information on this update, click here.

Visit NHPCO’s Quality Resource Center for more information regarding Quality updates, standards, performance measures, reporting measures, and guidelines.

Perspectives from the NHPCO Joint Board and Committee Meeting

Last week, I had the pleasure of meeting some leaders in the hospice and palliative care community during an NHPCO Joint Committee and Board Meeting in San Antonio, Texas.  While I was excited about the 15 degree weather difference and that good ole’ Texas beef and BBQ, I was also looking forward to meeting the individuals who I’ve been able to learn from during committee calls and associate names with faces.  Even though many of my interactions with these leaders were short, they were impactful, further educating me on the significance of this industry.

I spoke with people from all over the country who had completely different backgrounds, focuses, and experiences in hospice and palliative care, but behind all of those differences was one common theme – they all want greater patient access to hospice and palliative care and to ensure the sustainability of this industry in the healthcare universe.  During the Public Policy Committee Breakout Meeting, we discussed everything from eligibility changes, financial barriers, benefit structure, and staffing issues.  Although the meeting was long, our discussions never lacked intensity or passion.  It was clear that these leaders truly CARE.

Outside of formal discussions, I was able to have some short, eye-opening conversations with different members regarding their personal experiences in hospice and palliative care.  One committee member based in North Carolina expressed the impact the Rural Access to Hospice Act could have on rural communities. He jokingly told me a story about him and one of his physician friends who went hunting together.  They’d just crossed a county line and the committee member told the physician that the amount of doctors in the area had doubled.  There was only ONE – yes you read that right – ONE doctor that covered the entire county.  Imagine having an elderly family member who lives in a rural community with one doctor available within reach and that doctor cannot even provide hospice care due to regulatory barriers.  Of course, I understand the significance of the Rural Access to Hospice Act, but this story helped me understand the magnitude of this issue.  Another Public Policy Committee Member has no background in hospice or palliative care outside of personal experience and volunteer work.  She’s retired, but told me that one of her parents was on hospice care, and that encouraged her to volunteer at her local hospice.  She also told me that she now feels better equipped to handle dying and death, because of her encounters with hospice.  It’s amazing to know that hospice had such a profound impact on someone’s life, that they would devote their time to it, even after they’ve retired.

This meeting showed me just how diverse this industry is and how that diversity contributes to its overall success.  I’m so happy to know that these are the type of people who are leading the discussion and fighting for better, quality end of life care and I’m excited about what this year has in store!