VIEWS: 11 PAGES: 19 POSTED ON: 9/10/2011
Hospice Brad Chase Heather Goodroe Oren Kiriat Aimee Reeves Melissa Wahl HOSPICE Palliative care vs. intensive/invasive care Health Benefits Availability Added Utility? Cost-Effectiveness Employer Support Insurance Benefit Plans - Affordable - Comprehensive Focus Groups -1,502 Employers with 200 or more employees Coverage -83% of employees with explicit hospice benefits -High Cost Case Management Employer Support (cont…) Hospice Benefits -Attitude -Knowledge -Performance Measurement Number of Medicare Hospice Benefit Users (’92-’98) General Accounting Office (GAO) Use of hospice by non-cancer patients has increased 338% – 43% of beneficiaries using hospice are non- cancer patients – Physicians are reluctant to refer patients for hospice service – Referrals are often delayed until latter stages of disease Decline in Average and Median Hospice lengths of service (’92-’98) General Accounting Office (GAO) Providers report that shorter lengths of stay have created increased cost pressures – The more severe case mix requires more intense (and expensive) care – More types of care are demanded (radiation and chemotherapy for pain) – Fewer days to offset high costs at admission and immediately prior to death Medicare beneficiaries' costs of care in the last year of life Some statistics - 61% of health care costs in last year of life are covered by Medicare - 25% of Medicare expenses are attributable to last year of life - 19% of Medicare enrollees utilize hospital services - Medicare spending in last year of life is 27% Medicare’s role Outlays are stable part of total spending End of life policy should include coordination of acute, long term and hospice benefits between Medicare/Medicaid New policies should emphasize end of life care in benefit design Hospice care Hospice primarily for cancer patients Not an option for many because of hard to predict life spans Lack of care produces costly gap Patients not in MC and not dying of cancer have very little support Providing care at the end of life: Do Medicare rules impede good care? Providers believe that the hospice reimbursement rate is not high enough to meet demands for current treatments. This may be leading to denial of services to those with high-cost care demands. Per day expenses are typically higher in the first days of hospice care, and at the end. Shorter lengths of stay have contributed to budget shortfalls of 5-12% for 8 of the 10 hospices studied. Federal scrutiny regarding the eligibility rule of a prognosis of 6 months or less contributed to the delay in referrals. Do Medicare Rules Impede Good Care?…cont. Larger or chain hospices are better able to manage costs through contracting. “Thrivers” - Forced discharge when prognosis is more than 6 months creates higher costs since the patient usually improves for a short time. Some private insurers implement caps or do not cover hospice at all. Commercial plans often carve out the higher cost treatments and pay separate FFS rates for them. Article Recommendations: Adopt a patient outlier payment policy, similar to hospital DRG policy. Readjust per diem rates to include new treatments and demands Pay a higher per diem for the first and last days of care Determine how hospice care will be affected by the prescription drug benefit Consider using capitation payments to control cost. Including Hospice in Medicare capitation payments: Would it save money? HMO vs. FFS - Hospice enrollment in the last calendar month of life HMO vs. FFS mortality rates Comparing estimated actual Medicare payments on behalf of risk-based HMO enrollees with simulated Medicare payments for the same enrollees assuming the inclusion of Hospice in Medicare capitation payments. HMO vs. FFS - Hospice enrollment in the last calendar month of life 27.0 percent of risk-based HMO decedents were enrolled in a hospice during their last month of life 19.4 percent of FFS decedents were enrolled in a hospice during the last month of life Differences were statistically significant (p<0.001) HMO vs. FFS mortality rates Beneficiaries in a risk-based HMO demonstrated a lower mortality rate than among beneficiaries in FFS Comparing actual Medicare payments with simulated Medicare payments When total actual payments for July 1998 were compared with the simulated total payments assuming capitation of hospice services, a $1.9 million difference was observed. This difference represents only 0.07 percent of actual payments for risk-based enrollees. The estimated savings equaled approximately $23 million per year. Conclusions and Questions The aging population and Hospice Quality of Care Gaps in Care Availability and utilization patterns The future of Hospice care Questions?
Pages to are hidden for
"Hospice"Please download to view full document