Thursday, June 25, 2009
Briefly - this week's NEJM has a report about hospice trends (free full-text here), focusing on issues to do with extended hospice lengths of stay, payment, and concerns that for-profit hospices are gaming the system a little (that language is not used, but implied). It doesn't directly mention 'hospice cap' issues but clearly those issues are relevant to the article. Mostly it summarizes MedPAC's recent recommendations and the impact implementing them could have on hospices.
The increasing proportion of lengths of stay exceeding 180 days and the variability in length of stay among hospices also convinced MedPAC that Medicare should change the manner in which patients are recertified for eligibility. After being deemed eligible by two physicians, one of whom is the hospice medical director, beneficiaries elect hospice care for defined periods, the first of which is 90 days. After a second 90-day period, patients can be recertified for an unlimited number of 60-day periods if their life expectancy remains 6 months or less. But after initial approval, recertification falls solely within the purview of the hospice's medical director, not the patient's physician. In an effort to improve adherence to the coverage criteria in determining eligibility, MedPAC has recommended requiring documented physician oversight as well as additional medical review of long stays at hospices with a disproportionate number of such stays — to "identify providers with inappropriate admissions or recertification practices."MedPAC also recommended that the Office of Inspector General investigate the prevalence of financial relationships between hospices and long-term care facilities "that may represent a conflict of interest and influence admissions to hospice" and examine the enrollment practices of hospices with patterns of unusually long or short stays.