Thursday, June 25, 2009
NEJM on for-profit hospices
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.
A quote:
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.
3 Responses to “NEJM on for-profit hospices”
June 26, 2009
". . . MedPAC has recommended requiring documented physician oversight.. ."
Please explain just who MedPAC is referring to.
Does this mean the "attending physician," who, in 99% of patients I see, is not involved in care. Some want updates; most do not want to be called for day-to-day orders.
I would agree that the first and last 30 days are the most intense, especially the patients who are not even on service for 30 days. The article makes it sound like a lot of patients are on service for months and months. Some are; many are not.
July 04, 2009
JG I don't think it's entirely clear but my sense this is part of Medicare's statements/guidelines more recently saying there should be more physician involvement in general: so probably both/either 'attending' physician or hospice medical director.
March 27, 2011
JG I don't think it's entirely clear but my sense this is part of Medicare's statements/guidelines more recently saying there should be more physician involvement in general: so probably both/either 'attending' physician or hospice medical director.
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