Millions of Americans are awaiting the fate of the Affordable Care Act (ACA) and how any changes or repeals could affect their health care. But would any kind of repeal or reform of the legislation by the new Trump administration have an impact on the hospice industry?
About 90 percent of people in hospice use the Medicare hospice benefit, which was passed by Congress in 1982. This Medicare benefit is separate from the ACA, and would not go away if ACA was totally repealed, though it is unclear if additional changes to Medicare or Medicaid will also be made.
The main portions of the ACA (also known as Obamacare) that would have any kind of effect on the hospice industry are the individual and employer mandates. The employer mandate is a requirement that all businesses with at least 50 full-time employees provide health insurance or pay a penalty. The individual mandate is a requirement of all individuals to either obtain insurance through their employer or through a government marketplace or pay a fine.
As a result of these mandates, Medicaid-funded services such as hospice or home care were in danger of being penalized because providing insurance was too expensive. To avoid incurring any penalty or paying hefty insurance costs, many of these employers restricted the hours of some employees to keep the number of full-time employees below 50.
This likely would cause a loss of continuity of care for some patients if employees are working shorter shifts. Many hospice and home care employers would likely welcome a repeal of the employer mandate so they could increase the number of full-time employees without large costs for insurance or government penalties.
Other parts of the ACA that are under review, such as providing coverage for young people under 26 under their parent’s’ plan and coverage for pre-existing conditions, would not have an effect on hospice care. So far, none of the changes discussed by members of Congress include getting rid of Medicare changes that resulted in billions of dollars of savings through cutting rates.
Other guidelines implemented by the ACA that affect hospices are unlikely to be repealed, as they have more to do with providing consistent and quality care.
ACA requires hospices to collect and track quality measures and data since 2014, so that the best and most consistent care can be provided for patients and their families.
“The survey will include questions on hospice provider communications with patients and families, hospice provider care, and overall rating of hospice,” the Centers for Medicare & Medicaid Services said.
It also requires hospices to obtain certification from a physician that the patient has a terminal illness with a life expectancy of less than six months both upon admittance and after 180 days under hospice care. This does add extra cost but does ensure the patient is getting appropriate care.
The data reporting is part of a gradual push towards medical entities being reimbursed for quality care rather than the “fee for service” model that is currently used. The hope is that consistency in better outcomes will result in cutting costs. About half of total Medicare spending for people who passed away during a given year went toward hospital inpatient expenses, while hospice and end-of-life care made up about 10 percent of Medicare spending, according to a Kaiser Family Foundation analysis.
In an earlier version of the Affordable Care Act, there was a provision that would have allowed for Medicaid reimbursement for advanced care planning as well as programs that would’ve generated more awareness about end-of-life care and planning. According to another Kaiser Foundation survey, 81 percent of adults say Medicare should cover discussions between doctors and patients about end-of-life treatment options and about 83 percent would like private insurance to cover these conversations as well. This provision was dropped before the final bill was passed and is unlikely something to be revived with the uncertain political climate surrounding health care.
While the Affordable Care Act did implement positive changes to hospice care and how it’s regulated, it is unlikely any of those smaller provisions would be repealed. If the employer mandate is revoked, it’s likely that hospices will change their staffing policies to what they were before Obamacare was implemented. Overall, people needing hospice care and their families will not see very much change in care.