Medicare rates could be adjusted for start and end of hospice care episodes, CMS report suggests

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Medicare payments could be adjusted to reflect how hospice services tend to be more intensive at the beginning and end, according to findings recently published by the Centers for Medicare & Medicaid Services Office of Information Products & Data Analytics.

Individuals frequently require more resource-intensive skilled nursing services when they enter hospice, then they have a period in which they receive more routine care, and then skilled care increases in their last days, the investigators determined. Their findings confirm previous research, they noted.

The pattern of care was most noticeable for longer hospice episodes, the authors determined. Episodes lasting one to seven days involved a high level of skilled nursing care each day. However, patient diagnosis did not appear to have a significant effect on the general pattern of resource utilization.

The findings could inform payment changes. The Medicare Payment Advisory Commission already has recommended changing the current system, of a flat-rate per diem, to one in which hospice payments are higher at the beginning and end of a care episode, the study authors noted.

Hospice payments have come under scrutiny in part due to high-profile cases of unscrupulous providers. Some have allegedly billed the government for years for unnecessary services or for patients who did not need hospice care at all.

The investigators were affiliated with the Health and Human Services Office of the Assistant Secretary for Planning and Evaluation, and the University of North Carolina at Chapel Hill Gillings School of Public Health. They analyzed Medicare claims for people who began their hospice care in April 2010 and died on or before Dec. 31, 2011. Acumen LLC and the HHS Office of the Assistant Secretary for Planning and Evaluation created a database of Medicare hospice users that included more than 3 million beneficiaries.

Findings appear in the Medicare & Medicaid Research Review.

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