Earlier this month, the Centers for Medicare & Medicaid Services dropped us into some uncharted territory. No, not the publication of the final rule for long-term care providers. I’m talking about the first-ever Hospice Utilization and Payment Public Use File, two sets of data that show us where the United States is currently in terms of hospice settings and spending — and that could show us where we’re about to go.
The PUF includes data breaks down where and how the $15 billion the agency spent on hospice care in 2014 was distributed. The data sets also show how many beneficiaries received hospice care in skilled nursing and other long-term care facilities, broken down by state, along with total hospice care costs and number of hospice providers.
There’s no doubt this data is important. CMS officials heralded the release as a step forward for transparency in the Medicare program, and a giant leap toward “better care and smarter spending.” But while this new information is rich, and one can easily lose track of time clicking through the numbers, it doesn’t mean too much without some context.
Enter David Friend, M.D., consulting managing director with BDO’s Center for Healthcare Excellence & Innovation. To David, the recently released data set reflects a growing need for hospice services, and the ongoing debate over where beneficiaries should be in their final days.
“The question that society’s going to face is that as people get older, and they’re facing the end of life, where is the appropriate place for them to be treated?” Friend told McKnight’s. “It’s not surprising that people in skilled nursing facilities are getting hospice. The question is in the long term, what makes sense for people?”
The answer to that question, Friend noted, is that skilled nursing facilities may not be the best place for some beneficiaries to receive hospice care. In Friend’s opinion, the healthcare industry needs to work on building an infrastructure where more beneficiaries can receive hospice services in the setting that fits best for them, instead of a setting that may prioritize prolonging their lives instead of providing comfort.
“There’s a mismatch between the care you’re getting and the care you need,” Friend said. “It’s a good thing that more people in skilled nursing facilities are on hospice, but my point is that that’s maybe not the best setting.”
That care “mismatch” is even more important to address as the healthcare world continues to shift toward value based reimbursements, which is “forcing people to really think” about if patients are receiving care in the right place at the right cost, Friend emphasized. For skilled nursing providers the value based revolution also means realizing that they’re part of a care supply chain, even if that realization brings some discomfort.
“[SNFs] need to increasingly focus on making sure patients are in the right place, at the right time, at the right cost. If that means not being in a SNF but somewhere else, [providers] have to be very aggressive in making sure patients get the right care as opposed to trying to fill beds,” Friend said. “This is scary to a bunch of SNFs, who think our business is to fill beds. If you think that’s your business, you’re going to go out of business.”
So what might the next hospice PUF release look like? Perhaps it will show increasing numbers of Medicare beneficiaries who received hospice care. The total hospice payments may also decrease over time, as patients receive care in settings that give them comfort and comparable outcomes at a lower price. Whatever the future brings, Friend encourages long-term care providers to change in mindset when it comes to hospice care.
“Change your thinking to what your mission is. Be committed to the best care, do what’s best for the patient not what’s best for [you]. That’s a big change, but if you actually take care of your customer, your customer will give you business. And you’re going to thrive.”