Evaluation of Medicare's Hospice Reimbursement Structure: GAO Recommendations
The Government Accountability Office (GAO) has suggested that Congress evaluate potential alterations to Medicare's reimbursement structure for hospice routine home care by comparing it with home health payment systems. A recent GAO report indicates that approximately $7.6 billion could have been conserved from 2022 to 2024 if hospice care had been compensated through an adjusted home health per-visit rate instead of the existing hospice per-day payment model.
The analysis revealed that Medicare disbursed about $16.7 billion for hospice care during the studied period, compared with a projected $9.1 billion expenditure under a per-visit system similar to home health. The report emphasizes that "low-visit" hospices, mainly in regions known for high fraud, received significantly higher payments per visit than "high-visit" hospices under the current payment structure.
The National Alliance for Care at Home stressed that reform efforts should initially target fraudulent activities, suggesting that such measures could lead to more substantial savings than those outlined in the GAO's findings. They emphasized that hospice care is comprehensive in nature and requires a distinct payment structure compared to home health services. “The hospice daily payment rate is a deliberate design reflecting the nature of hospice care, unlike home health, hospice is a holistic, comprehensive benefit," they noted.
Despite concerns from the Alliance, Mollie Gurian from LeadingAge commented that the GAO's comparative approach offers a constructive starting point. “Their attempt to consider a per-visit payment by starting with home health and then trying to include elements that home health doesn’t cover is probably going to be a helpful starting point for us,” she remarked. Gurian acknowledged that the GAO's efforts to adjust their model may spark further discussion regarding the adequacy of home health payment rates, including considerations such as travel time.