CMS announced Friday that it intends to increase payments to hospice, skilled nursing and inpatient rehabilitation facilities in the next fiscal year.

Under three separate proposed rules, CMS said hospice payments would increase by 2 percent ($330 million), Medicare skilled nursing facilities by 2.1 percent ($800 million), and inpatient rehabilitation facilities by 1.6 percent ($125 million).

The proposed rule for hospice also provides a description of the Hospice CAHPS® Survey, including the model of survey implementation, the survey respondents, eligibility criteria for the sample, and other details. CMS said for the FY 2019 Annual Payment Update, hospices must collect survey data on an ongoing basis from January through December of calendar year 2017.

The agency further proposed two new hospice quality measures. One is a measure that will assess hospice staff visits to patients and caregivers in the last week of life. The second will assess the percentage of hospice patients who received care processes consistent with guidelines; that measure will be based on select measures that are currently being submitted under the Hospice Quality Reporting Program.

CMS is proposing one new assessment-based quality measure, and three claims-based measures for inclusion in the skilled nursing Quality Reporting Program. The assessment-based measure is focused on pharmacy and medication reconciliation. The claims-based measures include Discharge to Community, Medicare Spending Per Beneficiary, and Potentially Preventable 30 Day Post-Discharge Readmission Measure for SNFs. These measures are aligned with quality reporting required for inpatient nursing facilities.

Our Take: The home health lobby in Washington is one of the worst in the business. For all its efforts, ever since the Affordable Care Act was implemented CMS has slashed reimbursement rates year after year. The value-based reimbursement pilot, announced in July 2015, feels cobbled together as an afterthought, required by law but not much more than that. Friday’s announcement was a strong sign of support for post-acute care providers—with the exception of home health.

But instead of blaming the problem entirely on ineffective lobbying, we continue to posit that CMS is lowering home health rates and moving to value-based reimbursement in order to squeeze smaller providers out of the business. Right or wrong, the agency has followed the MedPac Advisory Committee's advice that home health companies are too numerous and too profitable.

We can think of no other reason why home health is being singled out among all players in the post-acute care continuum.

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