Hospice Visit Patterns in the Last Seven Days of Life and the Service Intensity Add-On Payment

Pedro L. Gozalo, Joan Teno, Carol Spence

Research output: Contribution to journalArticle

3 Scopus citations

Abstract

BACKGROUND: Hospice in-person visits in the last week of life are critical to ensure quality of care. In 2016, The Centers for Medicare & Medicaid Services (CMS) introduced a Service Intensity Add-on (SIA) payment for in-person routine home care (RHC) visits by a registered nurse or social worker in the last 7 days of life.

OBJECTIVES: The aim of the study was to examine visit patterns in the last week of life and provide SIA payment impact estimates.

DESIGN/MEASUREMENTS: Hospice data from 42 volunteer hospice programs for the 6-year period of 2005-2010 were examined. The data included information on the type and duration of visits/other care, the staff discipline, and patient demographics, diagnoses, date of death, and care setting (home, assisted living, nursing home).

RESULTS: In their last week of life, 251,407 decedents received 2,818,695 visits during 1,352,638 RHC days. Forty-four percent of the decedents had at least one SIA-eligible visit (in-person direct care visit by a registered nurse (RN) or social worker (SW)); 6.6% had only phone contact, and 30.4% had no hospice contact. Rates of RHC days with SIA-eligible days varied considerably across hospices (31% to 60.9%). For the 86.3% decedents with any SIA-eligible visits, average SIA payment would have been $202.5 (Median = $177.2, inter quartile range [IQR] = $108.3-$275.6), which represents a 21.6% increase over the average regular RHC payments received during the last week of life.

CONCLUSIONS: The relative size of the new SIA payment introduced by CMS has the potential to increase RN/SW visits and reduce disparities in visit patterns in the last week of life.

Original languageEnglish (US)
Pages (from-to)1378-1384
Number of pages7
JournalJournal of palliative medicine
Volume20
Issue number12
DOIs
StatePublished - Dec 1 2017
Externally publishedYes

Keywords

  • hospice care payment
  • hospice visit patterns
  • medicare hospice benefit

ASJC Scopus subject areas

  • Nursing(all)
  • Anesthesiology and Pain Medicine

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