For-profit hospices serve more extended-stay patients, are more likely to exceed Medicare cap than nonprofits, study finds

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For-profit hospices serve more extended-stay hospice patients than nonprofits, and are much more likely to file claims that exceed Medicare's aggregate annual cap for the hospice benefit, according to newly published findings.

Investigators at the Mount Sinai School of Medicine in New York City analyzed data from nearly 600 Medicare-certified hospices nationwide.

About 30% of patients at for-profit hospices have a “longer expected stay,” compared with 25% in nonprofit hospices, the researchers found. For-profit providers also were more likely than nonprofits to exceed Medicare's annual cap on hospice reimbursements, at a rate of 22% vs. 4%.

In addition, 10% of patients in for-profit hospices disenroll prior to death, compared with 6% in nonprofits.

“Although Medicare's aggregate annual cap may curb the incentive to focus on long-stay hospice patients, additional regulatory measures such as public reporting of hospice disenrollment rates should be considered as the share of for-profit hospices in the United States continues to increase," wrote the study authors.

The findings appear in JAMA: Internal Medicine.

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