Medicare Hospice Policy Changes and Beneficiaries' Rate of Live Discharge and Length-of-Stay

Authors

Kan Z. Gianattasio, Department of Health Policy and Management (K.Z.G., A.M.), George Washington University Milken Institute School of Public Health, Washington, DC; Department of Health Care Evaluation (K.Z.G.), NORC at the University of Chicago, Bethesda, Maryland. Electronic address: gianattasio-kan@norc.org.
Melinda C. Power, Department of Epidemiology (M.C.P.), George Washington University Milken Institute School of Public Health, Washington, DC.
Dale Lupu, George Washington University School of Nursing (D.L.), Washington, DC.
Christina Prather, Division of Geriatrics and Palliative Medicine (C.P.), George Washington School of Medicine and Health Sciences, Washington, DC.
Ali Moghtaderi, Department of Health Policy and Management (K.Z.G., A.M.), George Washington University Milken Institute School of Public Health, Washington, DC.

Document Type

Journal Article

Publication Date

12-13-2022

Journal

Journal of pain and symptom management

DOI

10.1016/j.jpainsymman.2022.12.001

Keywords

Alzheimer's disease and related dementias; Medicare; end-of-life care; hospice

Abstract

CONTEXT: The 2014 Improving Medicare Post-Acute Care Transformation (IMPACT) Act systemized audits of long hospice stays, and the 2016 two-tier payment system decreased daily reimbursement rates after 60 days of enrollment. Both aimed to reduce long stays. OBJECTIVES: Examine how live discharge rates and length of stay changed in relation to the policies. METHODS: We computed monthly hospice-level percent live discharges and length of stay using 2008-2019 Medicare hospice claims. We compared prepolicies trends and postpolicies trends overall, within Alzheimer's disease and related dementias (ADRD) patients, within lung cancer patients, and stratified by hospice ownership (for-profit vs. nonprofit/government-owned). RESULTS: We included 10,539,912 and 10,453,025 episodes of care in the analytical samples for live discharge and length of stay analyses, respectively. Overall percent live discharges declined during the prepolicies period (-0.13 percentage-points per month, 95% CI: -0.14, -0.12), but exhibited no significant change during the postpolicies period. Trends were driven primarily by for-profits, with similar patterns within ADRD and lung cancer patients. Overall, mean length of stay increased over time, with greater rate of increase during the postpolicies period (0.41 days per month, 95% CI: 0.39, 0.42) compared to the prepolicies period (0.12 days per month, 95% CI: 0.10, 0.14). Length-of-stay increased faster among ADRD patients, but changed minimally for lung cancer patients. CONCLUSION: Live discharge rates declined significantly during the prepolicies period, but plateaued after implementation of the policies, driven by changes in for-profits. However, the policies did not reduce length of stay, which increased at faster rates, suggesting that postpolicies excess live discharges were not restricted to long-stay patients.

APA Citation

Gianattasio, Kan Z.; Power, Melinda C.; Lupu, Dale; Prather, Christina; and Moghtaderi, Ali, "Medicare Hospice Policy Changes and Beneficiaries' Rate of Live Discharge and Length-of-Stay" (2022). GW Authored Works. Paper 2106.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/2106

Department

Epidemiology