Medicare Hospice Policy Changes and Beneficiaries’ Rate of Live Discharge and Length-of-Stay
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. Examine how live discharge rates and length of stay...
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| Veröffentlicht in: | Journal of pain and symptom management 2023-03, Vol.65 (3), p.162-172 |
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| container_title | Journal of pain and symptom management |
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| creator | Gianattasio, Kan Z. Power, Melinda C. Lupu, Dale Prather, Christina Moghtaderi, Ali |
| description | 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.
Examine how live discharge rates and length of stay changed in relation to the policies.
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).
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.
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. |
| doi_str_mv | 10.1016/j.jpainsymman.2022.12.001 |
| format | Article |
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Examine how live discharge rates and length of stay changed in relation to the policies.
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).
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.
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.</description><identifier>ISSN: 0885-3924</identifier><identifier>EISSN: 1873-6513</identifier><identifier>DOI: 10.1016/j.jpainsymman.2022.12.001</identifier><identifier>PMID: 36526252</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; Alzheimer's disease and related dementias ; end-of-life care ; hospice ; Hospice Care ; Hospices ; Humans ; Lung Neoplasms ; Medicare ; Patient Discharge ; United States</subject><ispartof>Journal of pain and symptom management, 2023-03, Vol.65 (3), p.162-172</ispartof><rights>2022 American Academy of Hospice and Palliative Medicine</rights><rights>Copyright © 2022 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c432t-e90c01f06c6d01cb96a243435647e3862fcaac8add91d9f020a5098a322649733</citedby><cites>FETCH-LOGICAL-c432t-e90c01f06c6d01cb96a243435647e3862fcaac8add91d9f020a5098a322649733</cites><orcidid>0000-0002-8665-2856 ; 0000-0002-3015-0187</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0885392422010090$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,776,780,881,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36526252$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gianattasio, Kan Z.</creatorcontrib><creatorcontrib>Power, Melinda C.</creatorcontrib><creatorcontrib>Lupu, Dale</creatorcontrib><creatorcontrib>Prather, Christina</creatorcontrib><creatorcontrib>Moghtaderi, Ali</creatorcontrib><title>Medicare Hospice Policy Changes and Beneficiaries’ Rate of Live Discharge and Length-of-Stay</title><title>Journal of pain and symptom management</title><addtitle>J Pain Symptom Manage</addtitle><description>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.
Examine how live discharge rates and length of stay changed in relation to the policies.
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).
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.
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.</description><subject>Aged</subject><subject>Alzheimer's disease and related dementias</subject><subject>end-of-life care</subject><subject>hospice</subject><subject>Hospice Care</subject><subject>Hospices</subject><subject>Humans</subject><subject>Lung Neoplasms</subject><subject>Medicare</subject><subject>Patient Discharge</subject><subject>United States</subject><issn>0885-3924</issn><issn>1873-6513</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkc1u1DAQx60K1C6lr1CZG5cEf8ROfKkEy0eRFrXi44o1dSa7XiX2YmdX2huvwevxJKRsW5UbJx_mN__xzI-QF5yVnHH9al2uN-BD3g8DhFIwIUouSsb4EZnxppaFVlw-ITPWNKqQRlQn5FnOa8aYkloekxOpldBCiRn5_glb7yAhvYx54x3S69h7t6fzFYQlZgqhpW8wYOedh-Qx__75i36GEWns6MLvkL712a0gLfEvu8CwHFdF7IovI-yfk6cd9BnP7t5T8u39u6_zy2Jx9eHj_PWicJUUY4GGOcY7pp1uGXc3RoOoZCWVrmqUjRadA3ANtK3hremYYKCYaUAKoStTS3lKLg65m-3NgK3DMCbo7Sb5AdLeRvD230rwK7uMO2uMaBpjpoCXdwEp_thiHu0wrYV9DwHjNltRK6VqZVQ1oeaAuhRzTtg9jOHM3vqxa_vIj731Y7mwk5-p9_zxPx8674VMwPwA4HStncdks_MY3GQpoRttG_1_jPkDxnypLA</recordid><startdate>20230301</startdate><enddate>20230301</enddate><creator>Gianattasio, Kan Z.</creator><creator>Power, Melinda C.</creator><creator>Lupu, Dale</creator><creator>Prather, Christina</creator><creator>Moghtaderi, Ali</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-8665-2856</orcidid><orcidid>https://orcid.org/0000-0002-3015-0187</orcidid></search><sort><creationdate>20230301</creationdate><title>Medicare Hospice Policy Changes and Beneficiaries’ Rate of Live Discharge and Length-of-Stay</title><author>Gianattasio, Kan Z. ; Power, Melinda C. ; Lupu, Dale ; Prather, Christina ; Moghtaderi, Ali</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c432t-e90c01f06c6d01cb96a243435647e3862fcaac8add91d9f020a5098a322649733</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Aged</topic><topic>Alzheimer's disease and related dementias</topic><topic>end-of-life care</topic><topic>hospice</topic><topic>Hospice Care</topic><topic>Hospices</topic><topic>Humans</topic><topic>Lung Neoplasms</topic><topic>Medicare</topic><topic>Patient Discharge</topic><topic>United States</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gianattasio, Kan Z.</creatorcontrib><creatorcontrib>Power, Melinda C.</creatorcontrib><creatorcontrib>Lupu, Dale</creatorcontrib><creatorcontrib>Prather, Christina</creatorcontrib><creatorcontrib>Moghtaderi, Ali</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of pain and symptom management</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gianattasio, Kan Z.</au><au>Power, Melinda C.</au><au>Lupu, Dale</au><au>Prather, Christina</au><au>Moghtaderi, Ali</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Medicare Hospice Policy Changes and Beneficiaries’ Rate of Live Discharge and Length-of-Stay</atitle><jtitle>Journal of pain and symptom management</jtitle><addtitle>J Pain Symptom Manage</addtitle><date>2023-03-01</date><risdate>2023</risdate><volume>65</volume><issue>3</issue><spage>162</spage><epage>172</epage><pages>162-172</pages><issn>0885-3924</issn><eissn>1873-6513</eissn><abstract>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.
Examine how live discharge rates and length of stay changed in relation to the policies.
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).
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.
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.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>36526252</pmid><doi>10.1016/j.jpainsymman.2022.12.001</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0002-8665-2856</orcidid><orcidid>https://orcid.org/0000-0002-3015-0187</orcidid></addata></record> |
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| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Aged Alzheimer's disease and related dementias end-of-life care hospice Hospice Care Hospices Humans Lung Neoplasms Medicare Patient Discharge United States |
| title | Medicare Hospice Policy Changes and Beneficiaries’ Rate of Live Discharge and Length-of-Stay |
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