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Do Live Discharge Rates Increase as Hospices Approach Their Medicare Aggregate Payment Caps?

Rachel Dolin1, Pam Silberman2, Denise A Kirk3

  • 1David A. Winston Health Policy Fellowship.

Journal of Pain and Symptom Management
|November 29, 2017
PubMed

Insights

Hospices nearing Medicare aggregate payment caps showed increased live patient discharges. This suggests financial incentives may influence end-of-life care decisions, impacting patient outcomes.

Area of Science:

  • Healthcare policy
  • Gerontology
  • Palliative care

Background:

  • Medicare aggregate payment caps aim to limit hospice expenditures.
  • Increased live discharges and cap exceedances have drawn federal attention.
  • Potential financial incentives may influence hospice discharge practices.

Purpose of the Study:

  • To investigate trends in hospice aggregate cap risk.
  • To examine the relationship between cap risk and live discharge rates.
  • To test the hypothesis that higher cap risk correlates with increased live discharges.

Main Methods:

  • Analysis of monthly hospice outcomes.
  • Utilized Medicare claims data from 2012-2013.
  • Employed adjusted statistical analyses.

Main Results:

  • A statistically significant positive association was found between cap risk and live discharges.
  • Hospices closer to exceeding their aggregate cap demonstrated higher rates of live discharges.

Conclusions:

  • The study highlights a potential unintended consequence of the Medicare aggregate cap policy.
  • Policymakers should evaluate the impact of aggregate caps on patient care and outcomes.
  • Further consideration of financial incentives in hospice care is warranted.
Abstract

Keywords:
HospiceMedicareend-of-life care

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