Post on 06-Jan-2016
description
What do short and long hospice stays tell us about Medicare policy?
Donald H. Taylor, Jr. Sanford School of Public Policy
Duke University
Some work funded by 2 grants• HCFO Initiative of RWJ: Identifying the Use,
Cost and Quality Tradeoff in the Medicare Hospice Benefit
• AHRQ 1RO1 HS018360: Priorities for Medicare Advanced Cancer Coverage
• Sponsors are not responsible for the presentation/my conclusions
Cordt Kassner, Hospice Analytics helped with slides & some of the empirical work I discuss. Policy conclusions/suggestions
are my responsibility
2012 Medicare HospicePercentage of Discharged Deceased x LOS
0 7 14 21 28 35 42 49 56 63 70 77 84 91 98 105
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0%
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100%
DC Deceased
Of those discharged deceased from hospice: - 25% die in 4 days or less - 50% die in 13 days or less - 75% die in 43 days or less
www.HospiceAnalytics.com 6
2012 Medicare HospicePercentage of Discharged Alive x LOS
0 7 14 21 28 35 42 49 56 63 70 77 84 91 98 105
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0%
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DC Alive
Of those discharged alive from hospice: - 25% are discharged by day 17 - 50% are discharged by day 57 - 75% are discharged by day 127
www.HospiceAnalytics.com 8
Short Stay Concerns• Quality• Foregone cost savings• Persistent: 1 in 4 dying 4-5 day LOS ~10 yrs • Problem or preference? – How can we lengthen short stays?– Worry: will changes exacerbate short stay
Long Stay Concerns• More likely to be discharged alive– Fraudulent– Inappropriate– Back door LTC benefit?
• Increase cost at longer length of use
Hospice Saves Medicare $ even w/long stays in N.C. (preliminary; static use)
N Mean Difference N Mean Difference N Mean Difference
Total 24,058 $11,925 24,058 $11,821 24,058 $11,452Control 12,029 $13,158 12,029 $13,161 12,029 $13,102Hospice 12,029 $10,692 -$2,466 12,029 $10,482 -$2,679 12,029 $9,802 -$3,300
Hospice Observed MEDPAC U-Curve Rebase -10%, No Update
Conclusions/What Next?• More focused audit• Hospice policy change inevitable. What is the
goal?• With appropriate comparison, hospice saves
Medicare money even with long stays– Could save more (worry unintended conseq)– Some long stay hospice back door LTC– What do patients want?
Final Thoughts• The hospice benefit in Medicare has been
expected to improve quality & save money since the beginning
• A very rare standard in health care• Hospice shouldn’t be the only part of
Medicare subjected to such questions