OIG releases report on a Medicare Hospice in Nursing Homes

Published Dec 22, 2007

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i thought this would be interesting to those who participated in the discussion about nursing facilities and hospice. there is a reason they are looking at this closely...medicare is looking for ways to cut spending.

oig releases report on a comparison of beneficiaries receiving hospice care in nursing facilities and in other settings

to: nhpco membership

from: nhpco regulatory team

date: december 21, 2007

the department of health and human services office of inspector general (oig) released a report (oei-02-06-00220) on thursday, december 20, 2007 entitled "medicare hospice care: a comparison of beneficiaries in nursing facilities and beneficiaries in other settings." this study is the first of a two part series. the second report will analyze the "nature and extent of hospice services provided to beneficiaries residing in nursing facilities and assess the appropriateness of payments for their hospice care."

the objectives of the report, as stated by the oig include:

1.to determine the percentage of medicare hospice beneficiaries who reside in nursing facilities.

2.to describe the characteristics of medicare hospice beneficiaries who reside in nursing facilities and compare these characteristics to those of hospice beneficiaries who reside in other settings.

the study described the characteristics of medicare hospice beneficiaries who resided in nursing facilities in 2005 and compares this population to medicare hospice beneficiaries who resided in other settings. the following data sources were used:

medicare part a hospice claims from the national claims history file, which identified beneficiaries who received hospice care in 2005 and their demographic characteristics.
minimum data set submitted by nursing facilities to identify hospice beneficiaries residing in nursing facilities.
oscar, the cms "online survey and certification reporting system" to identify tax status of hospice providers.

findings

number of beneficiaries: 871,437 medicare beneficiaries received hospice care in 2005.
- 28% of medicare hospice beneficiaries resided in nursing facilities for at least part of their hospice stay in 2005.
- 22% of beneficiaries were residents of nursing facilities for all of their stay in hospice and 6% were residents of nursing facilities for at least 1 day of their stay in hospice.
[*]payments: medicare payments for all medicare beneficiaries receiving hospice services in 2005 totaled $7.92 billion.

payments paid for beneficiaries receiving hospice services in nursing facilities totaled $2.55 billion. payments for these beneficiaries were 25% higher than for beneficiaries in other settings, due to a longer length of stay.
72% of hospice beneficiaries resided in other settings.payments for those beneficiaries totaled $5.37 billion.

[*]demographics:beneficiaries living in nursing homes were more likely to live in the midwest.30% of beneficiaries receiving hospice residing in nursing facilities in the midwest, compared to 21% in other settings.34% of beneficiaries in nursing facilities lived in the south, compared to 40% of beneficiaries in other settings. they were similar in race, reason for eligibility and likelihood of living in urban areas.

[*]diagnoses: there are differences in the diagnoses for hospice patients in nursing homes as seen in figure 2 below from the oig report.

length of stay: hospice beneficiaries in nursing facilities had lengths of stay of 80 days on the average in 2005. hospice beneficiaries in other settings had lengths of stay of 62 days on the average. 16% of hospice beneficiaries residing in nursing facilities spent more than 180 days in hospice care, compared to 11% of beneficiaries in other settings.

tax status: 30% of medicare beneficiaries being served by for-profit hospice providers were residing in nursing facilities compared to 23% among not-for-profit hospice providers.

in cms' response to the oig report, they commented that "this report provides a helpful general description of current utilization patterns." they also stated that they "anticipate that the research undertaken by the oig, medicare payment advisory commission (medpac) and others will illuminate various patterns of care for persons facing a terminal illness. the descriptive elements given in the current report will provide a useful platform for that work."

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note: this report, "medicare hospice care: a comparison of beneficiaries in nursing facilities and beneficiaries in other settings," is available in pdf from the oig web site. go to [color=#4b207a][color=#4b207a]http://oig.hhs.gov/oei/etoh.html and search for report #oei-02-06-00220 under the "hospice" section.

nhpco regulatory team reminds members that a number of useful materials and resources about hospice care in nursing home settings are available on the nhpco web site at www.nhpco.org/nursinghomes. this includes materials from the nursing home/hospice partnership project directed by susan miller, phd, as well as links to nhpco technical publications.

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