Use data to better manage hospice cap

On top of existing industry challenges like staffing shortages and ongoing regulatory changes, hospice agencies across the country also face headwinds in regard to managing the hospice cap.

Hospice cap explained

According to the U.S. Department of Health and Human Services, hospice cap was put into place to help ensure that hospice care does not exceed the cost of conventional medical care at the end of life — and this includes hospice at home. Medicare imposes two annual limits to payments made to hospice providers:

1. Inpatient cap: limits the number of days of inpatient care for which Medicare will pay to 20 percent of a hospice’s total Medicare patient care days (a hospice must refund to Medicare any payment amounts in excess of the inpatient cap)
2. Aggregate cap: limits the total aggregate payments that any individual hospice can receive in a cap year to an allowable amount based on an annual per-beneficiary cap amount and the number of beneficiaries served

From tight filing deadlines to overpayments that must be repaid to Medicare, cap regulations are complicated and can stall business growth for hospice providers. But when it comes to managing the hospice cap, it’s really about managing your entire hospice business — and data can help you do just that.

In this blog, we explore how data can help you better manage your hospice business — and ultimately, your hospice cap.

Data can help you automate cap management.

Instead of relying on manual cap management — i.e., using spreadsheets to evaluate risk — be proactive with automated data analyses that can help you make more informed decisions about whether you’re under the cap and how you can expand while staying under.

Data can help you better inform your customer base.

With the right data, you can see your status and plan ahead. Educate referral sources and be an informative resource so they understand what kind of patients you serve, how you care for them, and the capacity of your organization. Doing this in advance will reduce cap risk due to getting the wrong types of patients.

Data can help you know the right time to transition someone from palliative care to hospice.

Determining the best time to transition patients from palliative care to hospice is a challenge for many providers. Documenting on patients in a palliative care program allows you to look at data and better understand the expected length of stay, ultimately helping to start a path toward hospice care. This benefits the patient, the family, the payor, the provider, and everyone involved in the care journey.

The power of data doesn’t stop at better managing your hospice cap. When used in smart and innovative ways, it can help to improve the care you provide and expand your business.