Medicare costs rise as hospice stays lengthen, WSJ report finds

Increasingly long hospice stays have nearly doubled the amount Medicare is spending on patients in recent years, according to a new report from the Wall Street Journal.

Medicare's hospice coverage program was designed for patients who doctors deemed likely to die within six months, or 180 days. More than 106,000 beneficiaries received care averaging 1,000 days or more between 2005 and 2013, the report found. By that year, hospice spending climbed to $15 billion, almost double the amount eight years earlier.

Those beneficiaries with extended lengths of hospice care cost Medicare 14% of its hospice spending, although they accounted for slightly above 1% of hospice patients.

Fifteen years ago, the average length of stay for Medicare beneficiaries in hospice was 54 days, which climbed to an average of 88 days by 2013. At that time, more than a third of Medicare hospice payments were going to patients with at least a year of total hospice care.

Medicare's hospice shift from covering patients with terminal cancer — the program's original focus when it began 33 years ago — to those with conditions like dementia is likely behind in the lengthening stays, the Journal reports. For many beneficiaries, hospice allows them care that wouldn't otherwise be covered under Medicare.

The Journal report also cites some hospice providers who canvass nursing homes and other healthcare facilities in search of beneficiaries to enroll as a driver behind the rising costs and lengths of stay.

Recent changes to Medicare's hospice payment formula, including lowering daily rates after 60 days and increasing payments during the start of hospice care, aren't enough to lower costs, experts told the Journal.

Others argue a rise in hospice payments may reflect better care and appropriate treatments for end-of-life care, especially if the alternative is high-cost hospital stays.

For an insider's perspective on the increasingly volatile payment landscape, be sure not to miss Leah Klusch, RN, BSN, FACHCA, speaking on payment updates at McKnight's 10th Annual Online Expo. Klusch's session “MDS 3.0 Update: Get ready for more changes” will kick off the expo at 10 a.m. Eastern on Tuesday, March 29.

Expo attendees can earn up to five free continuing education credits, and network with top industry vendors, just by logging in through a computer or other internet enabled device.

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