Medicare hospices that focus on nursing facility residents

Use of hospice care has grown substantially, increasing from approximately 500,000 Medicare beneficiaries in 2000 to more than a million in 2008. Much of this growth is thought to have occurred in nursing facilities (NFs), a phenomenon which has been the subject of scrutiny and concern. A number of U.S. Department of Health and Human Services' Office of Inspector General (OIG) reports have investigated issues surrounding hospice in NFs. Notably, a prior OIG report found that 82 percent of hospice claims for beneficiaries in NFs did not meet Medicare requirements. In addition, the Medicare Payment Advisory Commission noted in a report to Congress that hospices and NFs may be involved in inappropriate enrollment. The OIG recently conducted a study on hospice in NFs that describes: (1) the growth of Medicare hospice in NFs; (2) hospices with a high proportion of Medicare beneficiaries in NFs; and (3) characteristics of beneficiaries served by high-proportion hospices. This study was based on an analysis of 2009 data, including Medicare claims, Minimum Data Set NF assessments, and hospice ownership information. The report will identify growth in hospice in NFs since 2005 and compare high-proportion hospices with all hospices. Points of comparison will include the prevalence of for-profit hospices, whether certain hospices receive more reimbursements, the predominance of diagnoses associated with long stays, and beneficiaries' care levels. The Affordable Care Act requires hospice payment reform after October 1, 2013, and our report will make relevant recommendations. We anticipate this report will be finalized April 2011.