Medalogix Muse and the Proposed Regulatory Changes for FY 2025

Steven Shelton, MBA, MSN, RN, CHPN; Director, Clinical Services

In the latest updates from the U.S Centers for Medicare & Medicaid Services (CMS) for FY 2025 there are critical regulatory changes proposed that will affect hospice providers, patients, and our healthcare system. These updates include potential negative impacts on operational budgets due to payment adjustments, alongside other changes geared toward enhancing patient outcomes. At Medalogix, we’ve curated key insights from this proposed rule to offer guidance on how our solutions can help organizations navigate and prepare for these impending shifts. 

Payment Updates

The proposed rule for FY 2025 brings about significant changes in payment updates for hospice providers. Despite MedPAC’s recommendation to eliminate the update, there’s a proposed increase of 2.6%, translating to a substantial $705 million rise compared to FY 2024 payments. However, industry consensus suggests that this increase may not adequately cover escalating costs like personnel expenses and inflationary pressures. Medalogix Muse is a hospice solution focused on resource management and operational efficiency and can help to alleviate these pressures. With Muse, hospice providers can strategize and optimize their resource allocation by utilizing the insights provided by Muse to assist in prioritizing patients according to their needs. This mitigates the impact of increased costs and regulatory changes such as those outlined in the proposed rule. This proactive approach helps organizations adapt and thrive amidst evolving healthcare landscapes and financial challenges.

Hospice Quality Reporting Program (HQRP) Updates

Medalogix Muse plays a crucial role in helping hospice providers navigate the updates to the Hospice Quality Reporting Program (HQRP) outlined in the FY 2025 proposed rule. With the introduction of the new HOPE instrument to replace the Hospice Item Set (HIS), Muse features become even more valuable. Muse surfaces patients at risk of not meeting elements of the HQRP and aids providers in managing to HQRP metrics, including the new measures introduced with the HOPE instrument.

Specifically, Muse can assist hospice providers in capturing and analyzing data related to the proposed new process measures, Timely Reassessment of Pain Impact and Timely Reassessment of Non-Pain Symptom Impact. These measures evaluate the timely reassessment of patients with moderate or severe pain levels or non-pain symptoms within a specified timeframe.

Muse’s capabilities extend to facilitating personalized care planning by identifying care needs during a patient’s dying process, aligning with the objectives of the HOPE instrument. Muse can help hospices streamline data collection during admission, discharge, hospice update visits (HUV), and Symptom Reassessment (SRA) visits, ensuring compliance with HQRP requirements.

By leveraging Muse’s features, hospice providers can enhance their quality practices and deliver better outcomes for their patients while staying compliant with evolving regulatory standards.

Hospice CAHPS Survey Updates

In addition to the implementation of the HOPE instrument, the proposed rule also updates the Hospice CAHPS Survey to improve understanding by respondents and efficiency of responses. The updates include a shortened survey with simplification of terminology, a new Care Preferences measure that includes two items, additional time for responses to surveys, and a web-based survey option

Clarification to Current Policies

The language of clarification for current policies includes clarifications to “election statement” and “notice of election” to provide stakeholders with better understanding of the differences between the two required documents. The clarifications indicated are not changes to policy; they are simply changes to “promote clarity and consistency”. The other language of clarification is the addition of “physician designee” to “clarify that a physician designated by the hospice, who is assuming the same responsibilities and obligations as the medical director, may certify terminal illness and determine admission to hospice care.”

FY 2025 Proposed Rule and Medalogix

The proposed two new process measures, Timely Reassessment of Pain Impact and Timely Reassessment of Non-Pain Symptom Impact, are process measures that Medalogix Muse is uniquely positioned to assist hospice providers. The Medalogix Muse tools allows clinical leaders unique access to each patient’s chart including current or potential symptom burden issues, via the clinical snapshot and the symptom burden icons located within the product. As more clarity is achieved around quality measures gathered utilizing the HOPE instrument, Medalogix teams will continue to explore ways to enhance features within Muse to ensure the new, symptom focused, process measures are featured, to assist client organizations in ensuring that patients are receiving the appropriate care and support as indicated by the HQRP and publicly reported. Learn more about Muse in Practice.

Resources

https://public-inspection.federalregister.gov/2024-06921.pdf

https://www.cms.gov/files/document/draft-hope-guidance-manualv100.pdf