Hospice and palliative care providers will need to leverage a robust suite of performance data when negotiating Medicare Advantage plans. While most providers track numbers on a range of metrics, they may need to consider a few more.
The US Centers for Medicare & Medicaid Services require MA plans to ensure they work with high-quality healthcare providers. To do this, plans look closely at star ratings, quality data such as palliative care item set, and Consumer Rating of Healthcare Providers and Systems (CAHPS) scores when they determine which providers to include in their networks.
But when working within Medicare Advantage, hospices will also need to measure their performance on additional criteria to stay competitive. This will likely include data on length of stay and use of non-hospital services, as well as information used to assess health equity.
“For [hospices that are] participating in a contract with an MA plan that is in a [Center for Medicare & Medicaid Innovation (CMMI)] model, there will be different types of data elements that will be collected that may not have been collected before,” said Annie Acs, director of policy and innovation for the National Hospice & Palliative Care Organization ( NHPCO) to Hospice News during the VALUE conference in Chicago.
The hospice component of the Value Based Insurance Design Demonstration (VBID) is entering its third year in 2023. Often referred to as hospice carve-in Medicare Advantage (MA), the program has already seen substantial expansion in terms of participation and of geography since its launch. on January 1, 2021.
This year, 115 MA planes are taking part in the demonstration, up from 53 in 2021, according to CMS. Additionally, the program is available in 461 counties nationwide in 2022, up from 206 in its inaugural year.
VBID marks the first step towards value-based reimbursement for palliative care and likely won’t be the last. As providers prepare to work in payment structures outside of traditional Medicare benefits, the importance of data becomes ever more important. This also applies to non-hospital services, such as palliative care.
Palliative care providers looking to the horizon have increased their investments in their data collection, analysis and reporting systems. But to maximize their returns, they need to make sure they’re tracking the right numbers.
“[MA plans] have a network of quality service providers. They also need to make sure they have data on which to call a high-quality provider,” said Katie Wehri, director of home health and palliative care regulatory affairs for the National Association of Home Care. & Hospice (NAHC) at VALUE. “Hospices need to make sure they can prove they are of high quality.”
Key metrics to monitor include lengths of hospice stay greater than 180 days or less than seven days, use of services outside of Medicare hospice benefits, and health equity data. According to Wehri and Acs, plans can also pay close attention to the incidence of acute care stays, hospice discharge followed by death, and duplicate Part D spending.
Hospices have come under scrutiny from other parties in recent years for these same issues, including CMS, the office of the Inspector General of the US Department of Health and Human Services.
But health equity data will most likely be a completely new consideration for most providers. This came out of a Executive Decree that President Joe Biden released in January, directing federal agencies to take action to improve equitable access to government services.
“One of the ways the administration is implementing and embedding this is by requiring MA providers to have a plan showing how they are improving health equity,” Acs told Hospice News. “And that, in turn, involves a plan with those contracted palliative care providers to show how that improvement is being made.”