Value-based care is typically viewed in terms of surgical procedures (both inpatient and outpatient) or specific conditions and diseases. But more specialties are turning to quality metrics and risk-based contracting. A recent Kaiser Health News (KHN) investigative report reveals how even hospice care is increasingly focused on quality metrics.

The need is highlighted by a number of troubling incidents at hospice centers around the country. Hospice care is covered by Medicare at a flat daily rate per patient: about $191 for the first 60 days and $150 per day after that mark. But since the rate is paid per day, even on those days wherein hospice workers do not provide care for a patient, the provider is still paid.

In a value-based model, hospices would be required to set certain standards of treatment. Rather than being paid based on services that may or may not be delivered, providers would be paid based on specific quality measures. In fact, there are already standards in place under MACRA pertaining to palliative care and hospice.

Hospices’ certification requirements are comparatively relaxed. CMS’s standards for hospice certification can shift each year based on the funding available. Further, aside from bi monthly assessment visits, many hospices do not have specific standards of care set down from the outset. They are required to regulate treatment on an individual basis, but what that entails can vary for each patient’s individual needs.

Under current requirements, there is a fair amount of room for undefined issues to pop up unannounced:

“To get paid a daily fee by Medicare … They must lay out a plan of care for each patient, ensuring they’ll treat all symptoms of the person’s terminal illness. And they’re required to be on call 24/7 to keep patients comfortable, but because each patient is different, there’s no mandate spelling out how often staff must show up at the home, except for a bimonthly supervisory visit.”

The personalized aspect of hospice care can be viewed as both a pro and con. The lack of specific requirements allows for individualized treatment, but also opens the door to potential quality issues and even negligence.

Trends that are driving healthcare to value-based care models may reach surprising segments of the industry, such as hospice care, even if full regulations are not yet activated.

“CMS has no statutory authority to impose those alternative sanctions … But it did increase transparency in August by launching a consumer-focused website called Hospice Compare that now includes hospices’ self-reported performance on quality measures and, next year, will include family ratings of hospices. Until that happens, there’s little information available for families trying to pick a hospice that will show up when it counts.”