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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
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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
CordtKassner, 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 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 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)
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