Hospice pay rule may actually drive more aggressive treatment, researchers say

A Medicare rule may have an opposite effect and lead to more aggressive end-of-life treatment according to a new analysis of patient outcomes.

The rule blocks some nursing home residents from receiving simultaneous reimbursement for hospice and skilled nursing facility (SNF) care at the end of life. The result in those cases may be more aggressive treatment and hospitalization, according to a new analysis of patient outcomes.

The study attempted to understand how treatments and outcomes vary for nursing home residents with advanced dementia who use Medicare SNF care near the end of life and who do or do not enroll in Medicare hospice, wrote researchers, including lead author Susan Miller, research professor of health services policy and practice at Brown University. The work was published Tuesday in the Journal of the American Geriatrics Society.

Unwanted treatments are often the outcome from not having hospice care, Miller said. People with SNF and hospice care concurrently were 87% less likely to die in a hospital, compared to individuals without hospice care. With hospice care after skilled nursing treatment, almost all (98%) were less likely, Miller said. She and her team of researchers studied Medicare records of more than 4,300 skilled nursing residents who had advanced dementia and died in 2006.

Given the high use of Medicare skilled care near the end of life and policy that prevents simultaneous Medicare reimbursement for skilled nursing and hospice care, aggressive treatments that may not be the preference of families or their loved ones are “unfortunately” common, Miller said. She noted that a demonstration project mandated by the Affordable Care Act should help clear up whether it would be cost-effective to change the payment policy.