The VBID (Value-Based Insurance Design) model is a voluntary program where Medicare Advantage Organizations (MAO) submit an application and undergo a bidding process to participate in the demonstration. As of January 2021, the Hospice benefit has been added to the VBID model. This means that if an organization has benefit packages that participate in the VBID model, the Hospice benefit is automatically included. If a Hospice admits one of their patients, the billing process will involve billing both the MAO and Traditional Medicare. The Medicare Advantage Organization will be responsible for paying the claim.
Over the past few years, we have covered numerous details about the VBID model through Monday Minutes, blogs, and webinars, which offer a deeper understanding of how the model operates. It may be helpful to review these resources as well. The National Association for Home Care and Hospice has kept us informed of updates, one of which is the demonstration period, which was initially set to end in 2025, has been extended through 2030. Currently, there have been no significant changes to the existing model or its components. However, there is an awareness that greater scrutiny and outcome measures will be enhanced throughout the demonstration going forward.
The main concern shared by many is that the Hospice component of the demonstration has encountered several challenges since the start of the demonstration, which is now in the third year. Both Medicare Advantage Organizations and Hospices have expressed concerns, as documented in the first annual report on Hospice participation. Furthermore, the extension of the demonstration until 2030 is worrisome as it raises the possibility that Hospice may become a permanent feature of Medicare Advantage plans.
Hospices that wish to remain viable within the Medicare landscape must take immediate action to assess the potential impact of Medicare Advantage on their operations if it becomes a permanent situation. It is crucial to consider how it could affect Hospice agencies and what opportunities it may provide. Although some states currently lack a participating Medicare Advantage Organization even in the third year of the demonstration, it is important to recognize that hospices nationwide will be affected if this model becomes permanent.
As a Hospice provider, I strongly advise you to review your current patient census, conduct an eligibility check for those patients, and assess how many of your patients are currently enrolled in a Medicare Advantage plan. This is particularly important if Hospice becomes a permanent component of the Medicare Advantage program. Even if Medicare Advantage does not directly affect you at present, you are likely to find that over 50% of your Hospice patients have a Medicare Advantage plan. This highlights the significance of the issue, and you should take action by meeting with Medicare Advantage Organizations in your area to express your interest in becoming an in-network provider of their Medicare Advantage plans when Hospice becomes part of their package. Make them aware of your presence and your desire to collaborate.
Being an in-network provider versus an out-of-network provider can significantly impact payment and the level of requirements needed to receive payment. It is crucial to have immediate conversations and meetings with Medicare Advantage organizations if you are a current Medicare-certified Hospice and do not have contracts with Medicare Advantage organizations in your area. It is essential to establish a relationship with them to ensure you receive the payments you deserve and meet the requirements for their Medicare Advantage plans.
If your Hospice is affiliated with a home health agency, a skilled nursing facility (SNF), or a hospital that already has contracts with Medicare Advantage Organizations, this can serve as your foot in the door. We strongly recommend that you initiate conversations with those organizations to explore potential opportunities for contracting as an in-network provider for their Medicare Advantage plans.
If Healthcare Provider Solutions can ever help you in any way, please don’t hesitate to reach out.
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