Hospice business is down, HME providers say

YARMOUTH, Maine - Hospice agencies are under the microscope as CMS pays closer attention to how patients are admitted. That translates into fewer hospice patients for HME providers, they say.

“Medicare has gone out and done a lot of surveys and audits and found that a lot of hospice agencies have been keeping their patients on too long,” said Tony Myrell, president of Colton, Calif.-based Premier Medical. “They've gone back to those agencies and said, 'You should pay us back for those patients, it was inappropriate hospice.'”

In June, the Huffington Post published an investigation into the hospice industry, which, according to the article, has quadrupled since 2000.

An increase in the allowed diagnoses has led to a boom of patients entering hospice care, say HME providers.

“Years ago, a relatively stable COPD patient who was on home oxygen wouldn't have a need for hospice service, but at some point, the inclusion of COPD as an admitting diagnosis for hospice really opened up their ability to garner new patient admissions based on that,” said Woody O'Neal, vice president of Pelham, Ala.-based O2 Neal Medical, whose company stopped taking new hospice patients because of declining reimbursement rates over the past five years.

CMS is also focusing on the services that hospice agencies are providing, or rather, aren't providing, said William Deary, CEO of Jackson, Miss.-based Great Lakes Caring.

“While reimbursement may not necessarily be declining, the bottom line is changing,” he said. “CMS is getting much more attuned to ensuring that hospices are providing all the services and support items, such as HME or pharmacologicals, they are required to provide.”

For example, some hospice agencies may have had patients pay for medications through their Part D plans, Deary explained.

The increased attention gets to the heart of responsible hospice, Deary said.

“Are you protecting the Medicare trust fund, which is one of your responsibilities as a Medicare provider, and are you admitting patients appropriately?” he said. “I think, basically, what's going on in the hospice industry is hospice is getting more scrutiny under CMS than it's received in the past and I'm going to say appropriately so.”