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This month, CMS (Centers for Medicare & Medicaid Services) published a final rule to be affecting the Medicare payments to hospice providers.

As CMS proposed in April this year, the final rule will increase payments to hospices by 1.8% or $340 million in the fiscal year 2019. This update is excellent news because this is higher than the previous increase of only 1% for the hospice payments for the fiscal year 2018. The aggregate cap of annual CMS payments to hospices increased by 1.8% also to $29,205.44.

Hospice providers that do not meet the quality reporting requirements as set by the Hospice Quality Reporting Program (HQRP) will now receive a 2% reduction in their CMS payments. These requirements include the two reporting metrics from the Hospice Item Set (HIS) and the Hospice CAHPS® Survey.

This implementation changes the timeline that hospices need to submit data for the HIS to four and a half months following the end of each quarter in a calendar year starting January 1, 2019. There were minor changes to the evaluation categories to CMS’s Hospice Compare program.

The update also will formally recognize physician assistants as designated attending physicians in hospices starting in 2019. This is a welcome change for both hospice providers giving them more staffing flexibility and hospice patients giving them more access to quality caregivers.

Also, the recognition of physician assistants helps fill a growing care need gap of HPM physicians. As a study published this April in the Journal of Pain and Symptom Management noted the supply of specialist HPM physicians is currently not adequate to service the hospice patient population. More worrisome, the “current training capacity is insufficient to keep up with population growth and demand for services.” The foresight of CMS to add physician assistants will be beneficial to address this issue starting in 2019.

CMS has published a Fact Sheet with the highlights or you can read the entire Medicare Program rule update here.


" My father, enlisted in the Air Force and trained as a machine gunner on B17’s during WWII. Photographs of the “Flying Fortress” grace the walls of his room in the Kansas Veterans' Home in Winfield, Kansas where he has been living for the past 6 years.

For the first 2 years in the Veterans’ Home, my father used a power wheelchair for mobility and independence. But at the age of 82, with advances in his Parkinson's and dementia, his power wheel chair was taken away for safety concerns. He was provided with a standard issue VA manual wheelchair with no tilt or recline. His posture in that chair was terrible ... he was very slumped over and leaning to the side. Even his breathing was limited as a result of his poor posture. All he could do was stare at the floor. It was so disheartening to see him this way. I would have to kneel on the floor to see him eye-to-eye due to his hunched posture from Parkinson's disease.

In a fortunate twist of fate, it was determined that my father was an ideal candidate for a chair from Broda. And as a vested veteran, he qualified for the VA to fund the chair. He has now had a Broda chair for over 4 years!

Since he's been in the chair from Broda we can now sit beside him on visits and look at each other face-to-face. Being able to tilt back in the chair and look upward, he can enjoy watching John Wayne westerns in the VA lounge. He can even use the Broda chair when he travels by transport for dental appointments. He can stay in his chair for the bus ride and in the office, since the chair can be tilted enough for the dentist to work on his teeth.

Broda's chair has been a blessing for my father, his caregivers and my family. The chair improves his quality of life and I can't imagine him not being in it over the past few years. We are fortunate that the VA will fund Broda chairs for Veterans like him who need them."

Kent P., Family Member

"Prior to using Broda's Elite Tilt Recliner, there were issues with safety for getting the resident out of the chair, safety for staff lifting her in, either manual/mechanical; comfort, keeping her in the chair, inability to get her body over the sides.

The chair sides raise to prevent her from throwing her legs/body over the sides; same with the extra padding along her leg area that is raised. The tilt puts her buttock in a comfortable position, but also makes it extremely difficult to push out. The chair sides also swing out to assist with ease of the mechanical tilt.

Broda's chair has given her a reason to want to get up and she enjoys her chair now. When we are using the mechanical lift she remains calm because she wants to get in it and will stay longer safely and comfortably! Staff can safely lift and position her without worrying about injuring themselves."

J. C., Unit Manager, RN |Campobello Island, NB

"The Broda Revive Tilt and Recline Shower Commode meets our patient's needs. He indicates he feels safe and his own care each morning. He is safe at all times while in the chair, and the caregivers are safe at all times while providing his care. All staff report being pleased with the commode and find it much easier to assist him."

Pam, Director of Nursing

"Prior to the Broda chair [Synthesis Tilt Recliner], we had tried numerous positioning devices for the resident, which were ineffective. She had a tendency to lean forward and to one side. Once using the Broda chair [Synthesis Tilt Recliner], the resident's posture immediately improved. She, herself, was very thankful because she was "so comfortable". The staff couldn't believe the result. Besides this resident sitting in proper alignment, she could still self-propel with her feet."

Linda P., Restorative Coordinator |Joliet, IL

"Broda chairs and wheelchairs make it easier for caregivers to provide optimal care with less stress on the client and the caregiver. For example, easier transfers, easier re-positioning, less maintenance, and easier mobility."

Carole P., MS/OTR |Easton, MD