Researchers Cite Rapid Growth in Medicare Hospice
Care, Suggest Change in Pay, Eligibility
Recommend changing rates of payment to reflect timing
of the more intense care needs; tighter rules for determining hospice
eligibility
July 9, 2010 The length of care in an average
Medicare-certified hospice program in U.S. nursing homes has doubled in
the last 10 years, which seems to have led to a 50-percent growth in the
number of hospices, primarily for-profit hospices. Currently, one-third
of Medicare beneficiaries who die in nursing homes are accessing hospice
services, and this new study predicts this number will increase.
The study by researchers at Brown University, which
will appear in the August issue of The Journal of the American
Geriatrics Society, evaluated hospice use in U.S. nursing homes
between 1999 and 2006.
It found the typical treatment time has increased
from 46 to 93 days. The researchers cited a standard daily payment rate
for most Medicare hospice enrollment days as an incentive for some of
the longer stays.
While the increased availability and use of
Medicare-sponsored hospice services was cited as a positive development
by the researchers, they are concerned that stays are longest in states
with the greatest provider growth. The study raises the possibility that
reimbursement policies could be contributing to the volume of these very
long stays.
"We undertook this study to inform efforts in
Medicare hospice reform," said Susan Miller, associate research
professor of community health at Brown University and lead author of the
report.
"Although we found a direct link between increases
in hospice enrollments and a rise in the number of providers, it is the
increasingly long lengths of stay we believe that raise policy concerns.
Still, we caution against making sweeping changes to the program, which
could deny nursing home residents hospice care. What is needed is a
tiered Medicare hospice payment system, which gives higher rates for the
beginning and end of the patient's treatment."
Recommend changes in pay and hospice eligibility
In addition to changing the rates of payment to
reflect the timing of the more intense care needs, the researchers agree
with a Medicare Payment Advisory Commission's recommendation that
procedures for determining hospice eligibility recertification be
strengthened.
The recommended changes would help the Medicare
system avoid undue scrutiny of nursing home residents who live beyond
the physician-certified six-month prognosis, a Medicare requirement for
hospice eligibility, and would allow patients to access the hospice care
they need. In 2006, 30 percent of nursing home hospice stays were found
to be seven days or less. Currently, 500,000 U.S. adults die in nursing
homes each year.
The Medicare hospice benefit is designed to provide
visits by an interdisciplinary care team to better manage pain and other
end-of-life issues and to provide psychosocial and spiritual support in
the nursing home setting for residents and their families. The authors
acknowledge the benefits that Medicare hospice provides to these
residents and families, while providing data that show a need for
modification of the payment system.
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boomers
July 9, 2010 The length of care in an average
Medicare-certified hospice program in U.S. nursing homes has doubled in
the last 10 years, which seems to have led to a 50-percent growth in the
number of hospices, primarily for-profit hospices. Currently, one-third
of Medicare beneficiaries who die in nursing homes are accessing hospice
services, and this new study predicts this number will increase. 