Regulators have focused on long-term stays in hospice, but people with dementia can be in dire straits.
According to a new study from the Journal of the American Medical Association, there are two policy changes to address the decline in hospice registrations for people with dementia. This includes an audit system created by the improvement of the Medicare Post-Accute Care Transformation (IMPACT) Act in 2014, and a two-step refund for regular home care with reduced payments after 60 days.
These efforts designed to prevent misuse of Medicare Hospice Benefits may have unintended consequences.
“We have found evidence suggesting that recent Medicare policy changes for patients staying in hospice care for a long time are associated with a sustained decline in the proportion of patients receiving hospice care. .. [Alzheimer disease and related dementias (ADRD)] Code compared to expectations based on pre-implementation trends, “the study author writes.
Researchers at George Washington University and the University of Chicago have investigated data on more than 11 million unique hospice care episodes that occurred between 2008 and 2019.
Increased utilization has increased Medicare hospice spending by approximately $ 1 billion annually. This has spurred the CMS to step up enforcement to prevent potential fraud from pushing up costs.
In recent years, agencies have begun to confirm that patients stay for 180 days or more as a danger signal that could lead to an audit. However, the longest stay tends to be associated with a particular diagnosis.
According to the National Hospice and Palliative Care Organization (NHPCO), the average number of people with dementia in 2019 was 126 days, while all hospice registrants were 92.6 days. For comparison, cancer patients that year were in hospice for an average of 45 days.
“Patients with ADRD may have been uniquely influenced by these policies, given that patients with ADRD are most likely to stay in hospice for more than 180 days and often have impaired ability to choose and defend themselves. There is sex, “the researchers observed.
Hospice, on the other hand, cares more for people with dementia and may expect more influx in the coming years. According to World Health Organization (WHO) data, the number of people with dementia is expected to increase by 40% by 2050, or 139 million worldwide.
For some stakeholders, increased dementia rates in hospice patients indicate that some aspects of the benefits of Medicare hospice need to be reassessed. Founded in 1982, the program was designed primarily with cancer patients in mind.
“The benefits of hospice itself need to be reformed. Previously, 80% to 90% of people who received hospice care were diagnosed with cancer, but profits have been established to meet that diagnosis.” Edvanach, President and CEO of NHPCO, said at the Hospice News Palliative Care Conference. Chicago. “Currently, more than 50% of people have dementia. It is the dementia patients who stroke the beard in the beltway beyond the long stay and live discharge rate.”
