Medicare Payment Policy

FIguRe
12–1
12-1
250
200
150
100
Length of stay (in days) FIGURE
50
0
Hospice...
growth in length of stay among hospice patients with the longest stays has slowed
2000
2008
2009
2010
2011
10th
Note: Length of stay is calculated for decedents who used hospice at the time of death or before death and reflects the total number of days the decedent was enrolled in
the Medicare hospice benefit during his/her lifetime.
Source: MedPAC analysis of the denominator file and the Medicare Beneficiary Database from CMS.
Note: Note and Source are in InDesign.
25 percent of stays were 5 days or less, unchanged from
Source:
the prior year.
The Commission has previously expressed concern about
very short and very long hospice stays. With very short
hospice
Notes
stays, the
about
concern
this
is that
graph:
patients enter hospice
too late to fully benefit from all that hospice has to offer.
As discussed • Data in our is in March the datasheet. 2009 report, Make a Commission- updates in the datasheet.
convened • panel WATCH of hospice FOR GLITCHY industry representatives RESETS WHEN YOU UPDATE DATA!!!!
indicated that very short stays in hospice stem largely from
• The column totals were added manually.
factors unrelated to the Medicare hospice payment system,
based on their preferences.
such as some physicians’ reluctance to have conversations
about hospice • I can’t or a delete tendency the to legend, delay such so discussions I’ll just have until to crop it out in InDesign.
death is imminent; difficulty some patients and families
may have in accepting a terminal prognosis; and financial
incentives default in the when FFS system you change for increased the data. volume of
services • (Medicare Use paragraph Payment styles Advisory (and Commission object styles) 2009). to format.
• I had to manually draw tick marks and axis lines because they kept resetting when I changed any data.
Some point to the requirement that beneficiaries forgo
intensive conventional care to enroll in hospice as a
• Use direct selection tool to select items for modification. Otherwise if you use the black selection tool, they
factor that contributes to deferring hospice care and
thus short hospice stays. PPACA mandates a three-year
demonstration at 15 sites to test the effect on quality and
The issue
•
of
Data
the FFS
was
system
from:
rewarding
R:\Groups\MGA\data
volume over
book cost 2007\data of allowing book concurrent 2007 hospice chp1 and conventional
quality is a broader issue that affects not only Medicare’s care. However, no funding was appropriated for this
hospice services but Medicare’s other services paid under demonstration, so its future is unclear. A few private
272 Hospice services: Assessing payment adequacy and updating payments
25th
50th
Percentile
75th
90th
FFS. Payment system reforms such as accountable care
organizations—which restructure incentives and focus
on the patient’s overall needs rather than fragmented
services—may help reduce financial incentives that can
deter hospice referral. With respect to the challenges
of physician–patient communication about advanced
illnesses, there may be potential for shared decisionmaking
tools to improve the timeliness and clarity of
information patients receive about their condition and
treatment options and empower patients to make choices
100
Ye
20
20
20
20
20