Managing The Beginning Of The End: Advanced Disease Management And Concurrent Care Under Current Financing

Editor’s Note: This is the second Health Affairs Blog post from the author on End of Life & Serious Illness. His first post “Why Now? Concerns About End-Of-Life Health Care Policy” was published on December 19, 2016. The Medicare hospice benefit was passed in 1982 as part of the Tax Equity and Fiscal Responsibility Act, the same bill that instituted diagnosis-related groups (DRGs) for hospital reimbursement. Since it was passed with a sunset provision, there was only modest growth in the number of beneficiaries until the hospice benefit was made permanent in 1986. Other changes included in the bill helped patients by allowing them to be under hospice care beyond the initial cap of 210 days. The challenge facing hospice and the six-month prognosis eligibility is that predicting survival is full of errors. Even though the median length of stay in the Medicare hospice benefit was 18 days in 2016, the average was around 70, and 11 percent of patients survived beyond six months. While such long-lived prediction errors may be surprises, almost half of all people admitted to hospice are dead within 14 days and 34 percent within seven days. This distribution is almost identical to that observed in the original National Hospice Study almost 40 years ago. If predicting six-month mortality is hard, trying to identify patients with life-limiting diagnoses who are candidates for “pre-hospice” services makes eligibility determinations even more ambiguous. The pur...
Source: Health Affairs Blog - Category: Health Management Authors: Tags: Costs and Spending End of Life & Serious Illness Long-term Services and Supports Medicare Organization and Delivery Quality advanced disease management End-of-Life Care Hospice care Palliative Care Source Type: blogs