Eli's Hospice Insider

Advisory body to Congress will circle back to this hot-button issue later this year.

The significant difference in key statistics for hospice patients residing in facilities continues to draw unflattering attention.

“It’s just striking that there are such different lengths of stays for the different facilities, and … even for the same diagnoses, there are different length of stays,” noted Commissioner Rita Redberg, a cardiologist at the University of California at San Francisco Medical Center, in the Medicare Payment Advisory Commission’s December meeting. “Are there any other differences, like in certain diagnoses tend to go to certain places? I’m just wondering why there are such differences.”

The feds have painted the significant difference in nursing home hospice patients’ stats as suspicious.

“You could go into a nursing home and sort of hit a number of patients at one shot and say, would you like a hospice benefit?” MedPAC Executive Director Mark Miller said in MedPAC’s Jan. 14 meeting.

“And, of course, that allows the nursing home to step back on the Medicaid side of things. And so, you see some length of stay issues there.”

But there are good reasons for statistical differences. “Patients with certain diagnoses tend to be in one setting more than another,” acknowledged MedPAC staffer Kim Neuman in the December meeting.

“There’s a higher proportion of [patients with dementia] in nursing facilities than patients with certain other diagnoses,” Neuman admitted. And of course, those are the longer-staying diagnoses.

Nevertheless, in its June 2013 report MedPAC analysis suggested a 3- to 5-percent reduction in hospice Routine Home Care payment for patients in nursing facilities may be warranted. MedPAC didn’t make it an official recommendation, though, Miller noted.

More on this ahead: “We can come back and give a more developed discussion of what’s going on there,” Miller said in the January meeting.