Cost report requirements under development
Cost report requirements under development
A committee of hospice representatives is now working with the Health Care Financing Administration (HCFA) to offer suggestions for the new hospice cost report mandated in last year's Balanced Budget Act. This group, which does not have the formal status of an "advisory group," has met once in person and once by conference call. It hopes to have draft recommendations for HCFA by the end of May, says Teresa Craig, CPA, vice president for finance and MIS of Hospice, Inc. in Wichita, KS, who is a member of the group.
The original hospice cost report was discontinued in 1992 after widespread dissatisfaction with the data submission. HCFA's goal for the new report is that it be small, efficient, and focused on generating data for rate setting.
Cost reporting requirements go into effect Oct. 1, 1998, for hospices whose fiscal years begin on that date, with gradual phase-in for others. The first of these new hospice cost reports will be due several months after the end of the first year, or the end of February 2000. However, exact specifications from HCFA could be up to a year away, Craig says, which could be a problem for hospices that must start collecting data without knowing exactly what will be required of them.
"A lot of information that will be required is not being kept. Hospices currently do not have the systems or the sophistication to produce the data HCFA will want, and even if they could, they haven't done it because it wasn't required," Craig says. "I think it will require some significant changes for many hospices, tracking new information or tracking it in the form that HCFA will want. On the other hand, a lot of this information would be very useful to hospice managers anyway."
HCFA is likely to require hospices to track expenses based on setting, for example, whether the patient lives at home or in a nursing home, she adds. "Nobody I know is doing that." Data to compute time spent by professionals on direct patient care, travel, or administration will also be needed, and hospices won't be able to provide that data unless their staff are filling out detailed time sheets to track how they spend their days. HCFA also warns that hospices failing to submit complete and timely cost reports may have their reimbursement frozen.
"HCFA is hopeful that this new cost report could be used to validate or adjust hospice rates," Craig says. "My hope is it would show that our costs are higher than our reimbursement. I've said it before: I don't see how you can make money providing good quality care under the current rates, unless your patient base is huge," she adds. "I hope people will look at the cost report in a positive way. The only way we'll get our reimbursement formula changed is by giving HCFA these data. We also told them we hope they'll give us back the data for benchmarking, so we can compare ourselves to each other."
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