Home Health & Hospice Week

Hospice payment changes have reduced access to hospice care for patients with Alzheimer’s, a new study in the May 6 issue of the journal JAMA Health Forum suggests.

“Did hospice use for persons with Alzheimer disease and related dementias (ADRD) change between 2008 and 2019 in conjunction with Medicare policy changes that aimed to reduce long hospice stays?” asks the study headed by George Washington University researchers and colleagues. In a study of Medicare claims data from more than 11 million unique hospice episodes, “there were immediate declines in the share of patients receiving hospice care with ADRD and a slower growth in use of hospice care among patients with ADRD after implementation of … the 2-tier payment system compared with pre-policy trends,” the study notes.

That two-tier system has lower reimbursement rates after 60 days of hospice care, the authors point out in the abstract. The IMPACT Act also required audits focused on longer-stay patients (180 days or more).

The study results “suggested that recent Medicare policies were associated with immediate and lasting reductions in the share of patients receiving hospice care with an ADRD code compared with expectations from pre-implementation trends,” the abstract concludes.

“Hospice is … particularly beneficial for many patients with Alzheimer disease and related dementias (ADRD) given the disease’s prolonged period of decline, uniquely burdensome symptoms and resulting dependencies, and lack of proven disease-modifying treatments,” the study notes.

On the other hand: That decline and slower growth “may reflect reductions in enrollment of patients with ADRD who did not truly meet eligibility criteria (ie, reduced eligibility), as the policy intended,” the study authors allow. “Alternatively, it may reflect unintended reduced access for hospice-appropriate patients with ADRD as hospices attempt to minimize risk of long stays, or some combination of these mechanisms,” though, they counter.

See the full study at https://jamanetwork.com/journals/ jama-health-forum/fullarticle/2791963.