TY - JOUR
T1 - Hospice Visit patterns in the last seven days of life and the service intensity add-on payment
AU - Gozalo, Pedro L.
AU - Teno, Joan M.
AU - Spence, Carol
N1 - Publisher Copyright:
© Copyright 2017, Mary Ann Liebert, Inc. 2017.
PY - 2017/12
Y1 - 2017/12
N2 - 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.
AB - 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.
KW - hospice care payment
KW - hospice visit patterns
KW - medicare hospice benefit
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U2 - 10.1089/jpm.2017.0214
DO - 10.1089/jpm.2017.0214
M3 - Article
C2 - 28622481
AN - SCOPUS:85048792003
SN - 1096-6218
VL - 20
SP - 1378
EP - 1384
JO - Journal of palliative medicine
JF - Journal of palliative medicine
IS - 12
ER -