MedPAC Report to Congress, March 2017 Edition

While millions of people across the Northeast are digging out from a late-winter snow storm, health policy professionals are digging into the annual Medicare Payment Advisory Commission’s (MedPAC) “Report to the Congress: Medicare Payment Policy.” Released every March, this report reviews payment policy across a variety of Medicare providers, including hospice.

The hospice chapter begins with an updated snapshot of the hospice industry. According to MedPAC, 1.38 million Medicare beneficiaries (or almost 49% of Medicare decedents) received hospice care in 2015 from 4,200 hospice providers. In that year, Medicare spent $15.9 billion on hospice care, up from $15.1 billion in 2014. However, Medicare spending on hospice care constituted less than 3% of overall Medicare spending.

This year’s chapter on hospice reflects the recommendation the Commission approved in January: “The Congress should eliminate the update to the hospice payment rates for fiscal year 2018.”  Don’t get alarmed just yet. Here are a few things to keep in mind:

  1. MedPAC has made this same recommendation to Congress for the following fiscal year since at least 2013.
  2. Congress must take action for a MedPAC recommendation to be implemented. Congress has not taken action to implement this recommendation in recent years.
  3. CMS will likely be bound by the 2015 Medicare Access and CHIP Reauthorization Act (MACRA), which mandated that the hospice payment update for FY 18 is limited to 1 percent, as we have reported in the past.
  4. Additional information about FY 2018 rates will be made available when CMS issues its annual hospice wage index update later this spring.

And you may remember that Congress has been rather busy lately. While Congress will certainly review the MedPAC report, they have many other priorities to address in the immediate future. HAN will continue to monitor any possible Congressional action based on MedPAC’s recommendation. If there are any developments, you can be sure to find updates on this blog!


Get Caught Up on #HPM News Here!

They say “April Showers Bring May Flowers,” but if your pollen count is as high as ours, you might prefer to stay inside and read up on the latest news from the hospice and palliative care community:

Advocacy Intensive 2016 Registration Now Open!

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Send us your front-line staff, and we will train them to be powerful advocates for the hospice and palliative care community! The event is free, and we have a discounted rate on hotel rooms. Learn more, and secure your spot today!

News from the Hill

Rural Access to Hospice Act Introduced

Palliative Care & Hospice Education and Training Act Gets Big Boost!

Congress Examines Frivolous Litigation under the False Claims Act

Congressional Hispanic Caucus Institute Panel on End-of-Life Care in Hispanic Communities


Regulatory Watch:

CMS Releases Proposed Hospice Wage Index Rule for FY 2017

Working on MCCM Fix

OIG Report Focuses on Hospice Inpatient Care

MedPAC Update


Advocacy Shout-Out:
Tarrah Schreiner, CEO of Sangre de Christo Hospice in Pueblo, CO, came to DC and met with Congressman Scott Tipton to discuss the importance of access to hospice and palliative care in rural communities. #HelpRuralHospice

Several Members of NHPCO met with Senator Ron Wyden to discuss the proposed Hospice/Medicare Advantage Carve-In.
Do you have a meeting coming up? Don’t forget to take a picture and tell us about it! You could be featured here!

Global Partners in Care presented the 2016 Global Partnership Award to Susquehanna Health Home Care & Hospice and Shirati Hospital Palliative Care

Susquehanna Medical Director Dr. Alexander R. Nesbitt on a home visit in Tanzania.
Susquehanna Medical Director Dr. Alexander R. Nesbitt on a home visit in Tanzania.

National Healthcare Decisions Day was April 16.  Our social media campaign was a smashing success; thank you to all who participated! Check out some of your stories here and here.

National Volunteer Week  honored volunteers across the country. Check out this beautiful video about hospice volunteers!

Looking Ahead:

Inviting a Member of Congress to your Program for Memorial Day Ceremonies 

National Nurses Week is May 6-12. Make sure you thank the nurses in your life!

May is Oncology Nursing Month

Join us on May 16 for a Webinar Presentation, “Top Advocacy Chef: A Recipe for the Perfect Meeting with Congress

As always, we are here to answer your questions, and please keep up in the loop with your advocacy activities! We love hearing from our advocates!

PS: Have you contacted your Members of Congress about the Medicare Advantage Carve-in, the Care Planning Act, and the Rural Access to Hospice Act? Please take a moment and tell your Legislators about these important hospice issues today!

Standing Room Only at the Horizon Ballroom

The hot ticket today in Washington, DC, was the monthly Medicare Payment Advisory Commission–MedPAC–meeting. The first session specifically, an update on a report mandated by the IMPACT Act on “Developing a unified payment system for post-acute care,” was standing room only! Representatives from across the post-acute world, consultants, and other related parties (like yours truly) filled the room. I also attended sessions on “Improving Medicare Part D” and “Hospice and Medicare spending.”

Today’s session on hospice focused on how much Medicare spends on the Medicare Hospice Benefit. The discussion among the Commissioners ranged from the evolution of the Benefit, raising awareness of hospice care before a patient may need it, concerns over both short- and long-lengths of service, POLST/MOLST forms, and more.

But let’s step back for a minute. What exactly is MedPAC? MedPAC was born in 1997, a child of the Balanced Budget Act. I’ve noted in previous posts that its purpose is in its name–to advise Congress on Medicare payment policy. MedPAC’s recommendations are non-binding, and require Congressional action to move closer to enacted policy.


WHO is MedPAC? The MedPAC website notes that “the Commission’s 17 members bring diverse expertise in the financing and delivery of health care services.” Commissioners are appointed to three-year terms, which are subject to renewal. You can view the current list of Commissioners here. MedPAC is served by Mark Miller, Executive Director, and a staff of subject matter and technical analysts. These are the folks with whom NHPCO an HAN staff maintain relationships.

What happens at the MedPAC meeting? The staff analysts present the most recent drafts of their reports to the commissioners. The commissioners follow-up with a round of clarifying questions, and then a round of suggestions for further inquiry. This second round, I find, is when the most interesting discussions among the staff and commissioners occur. Attendees are also known to take photos of powerpoint slides with recommendations not previously released.  Life before the iPhone must have been a dark time for policy wonks.IMG_2998


Keep your eye on the blog, folks, for future updates on MedPAC and the show in town!

Monitoring MedPAC

Today I spent 6 hours in the Horizon Ballroom at the Ronald Reagan Building and International Trade Center in downtown DC. I spent another 45 minutes waiting in line. All to see MedPAC: Live and In Person!


Okay, so it’s not a fancy song-and-dance show. The Medicare Payment Advisory Commission, or MedPAC, is a Congressionally-established, independent group of clinicians and health policy experts created to advise the U.S. Congress on issues affecting the Medicare program. While MedPAC recommendations are not binding, they are influential on Capitol Hill. Congress or CMS must take action on any MedPAC recommendation for the policy position to become law or part of regulation.

Two days a month, from September to May, the Commissioners gather to discuss a bevy of Medicare policy topics. Today’s meeting, the first day of the November meetings, covered topics ranging from “Sharing risk in Medicare Part D” to “Telehealth services and the Medicare program.” Staff present research to the Commissioners and recommendations are discussed. Two reports—issued in March and June each year—are the primary outlet for Commission recommendations finessed and approved in these meetings. In fact, you can find the hospice chapter from the March 2015 report here.

HAN and NHPCO actively monitor MedPAC’s activities throughout the year. Even when MedPAC is not “in session,” NHPCO and HAN staff engage MedPAC staff on topics pertaining to hospice. For example, when MedPAC first made a recommendation on hospice payment reform, Jon Keyserling and other NHPCO staff met with MedPAC staff to discuss the recommendation, research methodologies, policy implications, and potential impact on the hospice community. Attending these monthly meetings are often the first time we hear of a potential policy recommendation. Monitoring MedPAC’s activity gives NHPCO and HAN policy staff the chance to share ideas with staff before final recommendations are issued to Congress. And once they are, HAN staff and lobbyists are armed with the necessary information to discuss the proposals to Congress.

So while MedPAC meetings aren’t the most exciting shows in town (though it was standing-room only for a while this afternoon), attending these meetings is an important part of HAN and NHPCO’s strategy for preserving and protecting the Medicare Hospice Benefit for providers, patients, and their families.