Palliative Care News’ Post

Several of you have requested a recap of the recent CMS article on the CY 2025 Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Proposed Rule (CMS 1809-P). Key Takeaways from the CY 2025 Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Proposed Rule (CMS 1809-P): Payment Rate Updates: CMS proposes updating OPPS and ASC payment rates by 2.6% for hospitals and ASCs that meet applicable quality reporting requirements. This update is based on a projected hospital market basket increase of 3.0%, reduced by a 0.4 percentage point productivity adjustment (CMS.gov, eCQI Resource Center). Intensive Outpatient Program (IOP): The proposed rule updates Medicare payment rates for IOP services provided in hospital outpatient departments and Community Mental Health Centers (CMHCs). The existing rate structure, with different rates for three services per day and four or more services per day, will be maintained (CMS.gov, eCQI Resource Center). Partial Hospitalization Program (PHP): Similar to IOP, the rule proposes maintaining the current rate structure for PHP services, with two separate APCs based on the number of services provided per day. Payment rates will be based on CY 2023 claims data and the latest available cost information (CMS.gov, eCQI Resource Center). Access to Non-Opioid Treatments for Pain Relief: CMS proposes implementing additional payments for certain non-opioid pain treatments in hospital outpatient and ASC settings from January 1, 2025, through December 31, 2027. This initiative is part of the effort to expand access to non-opioid alternatives for pain management (CMS.gov, eCQI Resource Center). Behavioral Health and Health Equity: The proposed rule includes measures to address health disparities and expand access to behavioral health care. This aligns with the administration’s goals of promoting safe, effective, and patient-centered care, informed by lessons learned from the COVID-19 pandemic (CMS.gov, eCQI Resource Center). Refinement of Definitions and Policies: CMS is proposing to narrow the definition of "custody" to facilitate Medicare access for individuals on parole, probation, or home detention. This change aims to remove barriers to healthcare access for recently released individuals and those under supervision (CMS.gov). Comment Period and Final Rule: The proposed rule was published on July 10, 2024, with a 60-day comment period ending on September 9, 2024. The final rule is expected to be issued in early November (CMS.gov, eCQI Resource Center). These proposed changes reflect CMS’s ongoing efforts to update and refine Medicare payment systems, ensuring they remain equitable and effective in delivering healthcare services. Healthcare providers should prepare for these updates and consider the potential impacts on their operations and reimbursement strategies.

Navigating the healthcare system after a stroke can be overwhelming for individuals and their loved ones. In early 2024, the Center for Medicare and Medicaid Services (CMS) introduced a new model for post-acute care called Principal Illness Navigation (PIN). PIN aims to provide individuals with chronic health conditions with holistic support and access to timely and coordinated care as they go through their journey towards recovery. Check out our article about how PIN for stroke survivors can help reduce healthcare disparities and improve patient outcomes at https://lnkd.in/gHa8tjRG

CMMI introduced the Guiding an Improved Dementia Experience (GUIDE) model last summer. The eight-year program, launched by the Centers for Medicare & Medicaid Services on July 1, released the list of program participants on Monday. The GUIDE model aims to enhance dementia care by supporting patients and their caregivers, addressing inequalities, and potentially transforming healthcare innovation through improved delivery, quality, and outcomes. #Medicare #Medicaid #CMMI #GUIDE #healthcareinnovation #hospice

For adults 65 and older, health care spending has been increasing for decades, with per capita spending on aging people growing 4.5% between 2018 and 2020, compared with a 2.6% growth rate from 2016 to 2018. Now one state is making it easier for older adults and others to get care for serious conditions outside of a hospital. This spring, Hawaii became the first state to provide Medicaid coverage for palliative care in non-hospital settings under its state plan amendment. The change has the potential to reduce costs and improve health outcomes and quality of life for patients—and to serve as a model for other states. “In a lot of states, people can access services that fall under the umbrella of palliative care,” said Ella Taggart, a senior research analyst at the National Academy for State Health Policy, but now Hawaii “is able to comprehensively offer … the whole host of [palliative care] services.” Hawaii’s plan allows Medicaid benefits to cover the work of health and social services providers like community health workers, mental health professionals and others. It also defines palliative care as a preventative service, which means that Medicaid will cover comprehensive assessments, such as screening for diseases and psychological, neuropsychological and cognitive testing, to determine their care needs. Learn more here: https://lnkd.in/eW679suz

Today's #FocusFriday read: #DigitalDebut: ASCA Advocates for Changes to #CMS 2025 Proposed Payment Rule Centers for Medicare & Medicaid Services —via #ASCFocus Magazine

The end of the final year of the Centers for Medicare & Medicaid Services’ QIN-QIO 12th Statement of Work is fast approaching, but we’re not slowing down. Our new article “Say Sepsis, Save Lives: September is National Sepsis Awareness Month” offers important facts and lifesaving strategies to help long-term care facilities stop sepsis in its tracks. https://lnkd.in/gtuHkpv9 We have also updated our Sepsis Toolkit for skilled nursing and long-term care facilities to include more resources for patients and their family members. Get the kit at https://lnkd.in/g9MFdjW2. “Enhancing Dementia Care: A Guide for Long-Term Care Staff” explains why person-centered care strategies are key for enhancing quality of life for patients as well as how LTC staff can use these approaches with residents. https://lnkd.in/gFQzEidz As we prepare to bid on the 13th Statement of Work, we’re looking forward to the opportunity to support the providers, patients and communities in Region 6 — Alaska, Colorado, Idaho, Iowa, Kansas, Missouri, Montana, Nebraska, North Dakota, Oregon, South Dakota, Utah, Washington and Wyoming.

"Our health care system and our public health care system is woefully, woefully underprepared and underresourced. We've got to change that." - Jim Wessler, CEO, Alzheimer's Association, Massachusetts/New Hampshire Chapter 🚨 This story out of Massachusetts could have come from any state in the union. 🚨 Transforming the healthcare workforce to become more dementia-capable is built into Rippl's mission and drove the launch of Rippl Academy last year. There is so much need for care and support out there and it will take systemic change (like this year's launch of a new dementia care payment model by Centers for Medicare & Medicaid Services) to answer the call. We can and will do better for those #LIVINGwithDementia and their #caregivers. #createarippl #moregooddays More about Rippl Academy here: https://lnkd.in/e3DvNTzp More about the CMS GUIDE model here: https://lnkd.in/grE7BdTS https://lnkd.in/gF9QFSNn

Earlier this week, #ASCA submitted comments in response to the Centers for Medicare & Medicaid Services 2025 proposed payment rule for #ascs and #hospital #outpatient departments (HOPD). The comments included a proposal to continue aligning the ASC update factor with the one used to update #HOPD #payments beyond 2025; additions to the ASC Covered Procedures List; and changes to the ASC #Quality #Reporting Program. Dive in for details on how this affects your #surgery center.

"Live discharges are disruptive to patients and families and could mean that terminally ill individuals do not receive adequate care at the end of life, according to the two authors, who argue that these incidents are critical care transitions that contribute to increased hospitalizations and emergency department visits.“ Although a discharge due to stabilization or lack of decline might sound like a positive outcome — and is often presented as such by hospice teams — most individuals are left struggling to replicate the supportive services that hospice provided — medication delivery, supplies and equipment, access to support around the clock, and routine visits with interprofessional team members,” the authors wrote. “When these services cannot be replicated, patients and caregivers are left to deal with the loss of these services, citing experiences of grief and abandonment.'" #hospicecare #medicare #endoflifeadvocacy

#PalliativeCare services can make sense for a Program of All-Inclusive Care for the Elderly (#PACE) organization for several reasons: 1. #ComprehensiveCare Approach: PACE orgs aim to provide comprehensive care to their participants, addressing their medical, social and emotional needs. Palliative care fits into that by focusing on improving the quality of life for individuals facing serious illness, regardless of their prognosis. 2. Meeting participant needs: Many of those enrolled in PACE have multiple #chronicconditions and may benefit from palliative care to manage symptoms, alleviate pain, and address emotional and spiritual concerns. 3. Enhanced #carecoordination: Palliative care involves a team-based approach with coordination between medical professionals, social workers, spiritual advisors and other specialists. This aligns with the interdisciplinary care model typically employed by PACE. 4. Support for families: Palliative care also extends support to participants' families, providing counseling, education and assistance with decision-making. This can be particularly valuable for PACE participants and their families as they navigate complex #healthcare decisions. 5. Alignment with PACE principles: PACE emphasizes the importance of participant-centered care, which aligns with the principles of palliative care that prioritize the individual's goals, values and preferences in treatment decisions. 6. Cost-effectiveness: Providing palliative care services within the PACE model may also contribute to cost savings by preventing unnecessary hospitalizations, reducing emergency room visits and promoting efficient use of healthcare resources. Jim Parker, editor of Hospice News and Palliative Care News, explores this intersection here: https://lnkd.in/gS5MpjwE