OIG: Medicare payments for hospice care need reform, accountability

Medicare payments for hospice care carried out in an assisted living facility (ALF) more than doubled from 2007 to 2012, raising questions about the incentives that Medicare provides for hospice care, according to a report from the Office of Inspector General (OIG).

Hospices provided care for longer periods of time to beneficiaries in ALF settings than for beneficiaries in other settings, OIG said--98 days, compared to 50 days for those who stay in a nursing facility. ALFs also received much higher Medicare payments--more than $16,000 per beneficiary, twice the amount of a nursing facility.

In general, hospice care can save money and reduce hospitalizations, along with reducing the need for acute care services. However, OIG has had its eye on hospice care for some time. In 2009, for example, OIG found that 82 percent of hospice claims for beneficiaries in nursing facilities did not meet Medicare coverage requirements, the report said.

To be eligible for Medicare hospice care, a beneficiary must qualify for Medicare Part A and have a terminal illness with a life expectancy of less than 6 months. They are entitled to care for two 90-day periods, followed by an unlimited number of 60-day periods. One-third of beneficiaries in an ALF received hospice care for more than 180 days, OIG said.

Overall, the report "raises questions about whether Medicare is paying appropriately for hospice care in ALFs and whether beneficiaries are receiving the services they need during their last months of life," OIG said.

A recent Institute of Medicine report recommended that insurers pay doctors to discuss end-of-life care, FierceHealthPayer previously reported. This, too, can reduce hospitalizations and the need for acute care. What's more, limits on end-of-life care can save nearly $5,600 per patient.

OIG issued five recommendations for the Centers for Medicare & Medicaid Services. They include reducing the incentives that let hospices target beneficiaries likely to have a long stay in an ALF, adopting claims-based quality measures and making hospice data publicly available.

For more:
- read the OIG statement and report (.pdf)

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