Puerto Rice Hospice Carve-In Could Have Implications Nationwide

Posted on Monday, November 16, 2020

CMS is adding hospice component to the Medicare Advantage Value-Based Insurance Design (VBID) Model starting in January. Spanning a four-year period, and it could have long-term impacts for on all hospices.

The program will be available to beneficiaries in 13 states and Puerto Rico.  Of the plans that are offering the carve-in, more than 20 are from Puerto Rico, which represents almost half of the current overall Medicare Advantage hospice penetration rate.

“Medicare Advantage penetration rates in Puerto Rico are at the highest, with 72% penetration according to the recent Medicare numbers,” said Kevin León, president of miEMR Inc., an electronic medical record and billing software company for hospices based in San Juan. “The scenario in Puerto Rico is not the same that you are living in the [mainland] United States because we are starting with 400,000 patients out of 600,000 patients who are under managed care with Medicare Advantage organizations. That represents 66% of the total amount of patients enrolled who are going straight into that model. That represents those 400,000 lives. The amount of Medicare Advantage organizations working under the pilot [in the mainland United States] will be very, very low when you compare it to Puerto Rico.”

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