FY 2022 Hospice Wage Index & Payment update final rule
The FY 2022 Wage Index was published in the Federal Register on August 4, 2021. All regulations will take effect on October 1, 2021. Below are the main sections the wage index addresses. If you are a member of NHPCO or NAHC you can find their interpretations of the new rules on their websites.
- The final hospice rate increase for FY 2022 is 2.0%.
- The final hospice cap amount for FY 2022 is $31,297.61.
- NHPCO has prepared the FY 2022 Final Wage Index State/County Rate Chart, which is found on the Regulatory Medicare Reimbursement page of the website for members.
- Technical changes and clarifications to the election statement addendum were finalized.
- Two 1135 waivers were made permanent.
- Hospice Care Index finalized.
- Updates on the HOPE Assessment Tool were detailed.
- Hospice CAHPS® Star Ratings finalized.
deprescribing: Antipsychotics
“Antipsychotics are commonly used in the elderly, particularly in those residing in long-term care (LTC) facilities, to control certain behavioral and psychological symptoms of dementia (BPSD) including delusions, hallucinations, aggression, and agitation when there is potential for harm to the patient or others. A 2014 meta-analysis demonstrated statistically significant improvements in symptoms of BPSD as measured using 5 different scales for patients taking atypical antipsychotics compared with placebo. However, antipsychotic treatment initiated for BPSD is often continued chronically, despite a lack of documented ongoing indications for many patients. Because behavioral features of dementia change over time as the disease progresses, it is important to reassess the continued need for treatment.” www.deprescribing.org
Antipsychotics have been associated with numerous side effects, including drowsiness, dizziness, restlessness, weight gain, dry mouth, constipation, nausea, and vomiting. The most severe of which are increased overall risk of death and increased risk of cerebrovascular adverse events especially in the frail elderly.
Current research supports deprescribing antipsychotics for adults with behavioral and psychological symptoms of dementia treated for at least 3 months with symptoms stabilized or no response to an adequate trial. Research and clinical practice also inform us that antipsychotics should not be abruptly discontinued especially if the patient has been on for weeks to months and/or on a high dose. Ideally, the titration down to discontinuation should be done over weeks. However, most hospice patients may not have that amount of time.
Patients on the lowest dose of an antipsychotic may have the dose discontinued with reasonable monitoring to watch for rebound of the behavior(s). Those who have been on for a length of time at higher doses should have their dose tapered 25%-50% every 1 to 2 weeks.
In order for this process to be successful, it is imperative that the patient and family be engaged from the outset. Answer questions thoroughly and provide assurances that this process will be monitored closely for any signs of adverse events and how those events will be addressed.
For more information and resources contact David Bougher at dbougher@wiseop.com
drug shortage list
These shortages are due either to manufacturing delays or shortage of raw ingredients. This is not an inclusive list, but the listed drugs may be used for hospice patients, especially in the inpatient setting.
For a complete list of drugs on shortage follow this link:
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About the author
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David Bougher
Senior VP of
Regulatory Affairs
David is a seasoned veteran of the hospice world and an essential member of the Wise Hospice Options clinical team.
Education:
RN, BSN
Experience:
- Former hospice COO
- 20 Years of education & training experience
- 10 Years of experience at Wise Hospice Options
Connect
- (800) 856-9757 Ext: 203
- dbougher@wiseop.com
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clinical leadership
Tino Vilches
senior vice president of clinical services
Deanna Rice
vice president of clinical services
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