Tuesday, November 10, 2009

How Often Do Hospice Staff Make a Visit?

MedPAC (Medicare Payment Advisory Commission) released a brief and a presentation from a November 5th meeting from a session covering frequency of hospice visits and extrapolating that information to the Medicare reimbursement structure for hospice agencies.  Since most hospice agencies have a large majority percentage (around 80-85%) of patients on Medicare any tinkering of the reimbursement structure is bound to get some administrator's attention.


337/365: The Big MoneyImage by DavidDMuir via Flickr
The fact of MedPAC examining this issue is not new for they have been doing so for the last several years.  In early 2009 they made a recommendation to increase payments at the beginning and end of a hospice stay.   The purpose was to reflect the higher care needs around admission to hospice and near the time of death.  Bloggers and organizations commented on this:

Any hospice staff should read the brief and the presentation (it will take you all of 20 minutes) and many palliative care providers who are not in hospice should understand these issues on the surface at least.  Here are a few key facts from each since I have a feeling not everyone will go read it like I suggested.  (Hey, we are all busy!)

Background:
  • In March 2009 MedPAC recommended increasing reimbursement at beginning and end of hospice stays (a U-shaped pattern)
  • Medicare currently pays hospice in a flat per-diem, thus making long admissions more profitable
  • This was based on data from VITAS a national for-profit hospice

New Info:
  • Since the reimbursement recommendation was based on data from one hospice, the recommendation may not have the strongest scientific/economic foundation.
  • They now have two new data sources: Medicare claims data from 7/08-12/08 & 17 non-profit hospices visit data from 10/05-09/08 

What MedPAC Found (some great graphs for this in the presentation):
  • # of visits does not differ by diagnosis when adjusted for length of stay
  • # of visits and visit hours are increased for short stays when compared to long stays
  • Patients in nursing homes and assisted living get more visits than home patients*


The data did not make much comparison between the for-profit and non-profit data.

If you leave any comments here I will be happy to forward them on to MedPAC unless you tell me otherwise.  If you want to comment directly to MedPAC you can email them.

*At first I was surprised at this fact, but then I guess it makes sense that nursing home patients would get more visits because of the increased efficiency in seeing multiple patients in one central location.

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