Rachel Dolin1, Pam Silberman2, Denise A Kirk3, Sally C Stearns2, Laura C Hanson4, Donald H Taylor5, G Mark Holmes2. 1. David A. Winston Health Policy Fellowship. Electronic address: rdolin@winstonfellowship.org. 2. Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. 3. The Cecil G. Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. 4. Palliative Care Program, Division of Geriatric Medicine, Center for Aging and Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. 5. Sanford School of Public Policy, Duke University, Durham, North Carolina, USA.
Abstract
CONTEXT: The rate of live discharge from hospice and the proportion of hospices exceeding their aggregate caps have both increased for the last 15 years, becoming a source of federal scrutiny. The cap restricts aggregate payments hospices receive from Medicare during a 12-month period. The risk of repayment and the manner in which the cap is calculated may incentivize hospices coming close to their cap ceilings to discharge existing patients before the end of the cap year. OBJECTIVE: The objective of this work was to explore annual cap-risk trends and live discharge patterns. We hypothesized that as a hospice comes closer to exceeding its cap, a patient's likelihood of being discharged alive increases. METHODS: We analyzed monthly hospice outcomes using 2012-2013 Medicare claims. RESULTS: Adjusted analyses showed a positive and statistically significant relationship between cap risk and live discharges. CONCLUSION: Policymakers ought to consider the unintended consequences the aggregate cap may be having on patient outcomes of care.
CONTEXT: The rate of live discharge from hospice and the proportion of hospices exceeding their aggregate caps have both increased for the last 15 years, becoming a source of federal scrutiny. The cap restricts aggregate payments hospices receive from Medicare during a 12-month period. The risk of repayment and the manner in which the cap is calculated may incentivize hospices coming close to their cap ceilings to discharge existing patients before the end of the cap year. OBJECTIVE: The objective of this work was to explore annual cap-risk trends and live discharge patterns. We hypothesized that as a hospice comes closer to exceeding its cap, a patient's likelihood of being discharged alive increases. METHODS: We analyzed monthly hospice outcomes using 2012-2013 Medicare claims. RESULTS: Adjusted analyses showed a positive and statistically significant relationship between cap risk and live discharges. CONCLUSION: Policymakers ought to consider the unintended consequences the aggregate cap may be having on patient outcomes of care.
Authors: Elizabeth A Luth; David J Russell; Abraham A Brody; Ritchell Dignam; Sara J Czaja; Miriam Ryvicker; Kathryn H Bowles; Holly G Prigerson Journal: J Am Geriatr Soc Date: 2019-11-21 Impact factor: 5.562
Authors: Elizabeth A Luth; David J Russell; Jiehui Cici Xu; Bonnie Lauder; Miriam B Ryvicker; Ritchell R Dignam; Rosemary Baughn; Kathryn H Bowles; Holly G Prigerson Journal: J Am Geriatr Soc Date: 2021-02-19 Impact factor: 7.538