2. What do short and long hospice stays tell us about Medicare policy?
Donald H. Taylor, Jr.
Sanford School of Public Policy
Duke University

3. Some work funded by 2 grants
HCFO Initiative of RWJ: Identifying the Use, Cost and Quality Tradeoff in the Medicare Hospice Benefit
AHRQ 1RO1 HS018360: Priorities for Medicare Advanced Cancer Coverage
Sponsors are not responsible for the presentation/my conclusions

4. Cordt Kassner, Hospice Analytics helped with slides & some of the empirical work I discuss. Policy conclusions/suggestions are my responsibility

6. 2012 Medicare Hospice Percentage of Discharged Deceased x LOS
Of those discharged deceased from hospice:
- 25% die in 4 days or less
- 50% die in 13 days or less
- 75% die in 43 days or less 6

8. 2012 Medicare Hospice Percentage of Discharged Alive x LOS
Of those discharged alive from hospice:
- 25% are discharged by day 17
- 50% are discharged by day 57
- 75% are discharged by day 127 8

9. Short Stay Concerns Quality Foregone cost savings
Persistent: 1 in 4 dying 4-5 day LOS ~10 yrs
Problem or preference?
How can we lengthen short stays?
Worry: will changes exacerbate short stay

10. Long Stay Concerns More likely to be discharged alive
Fraudulent
Inappropriate
Back door LTC benefit?
Increase cost at longer length of use

11. Hospice Saves Medicare $ even w/long stays in N. C
Hospice Saves Medicare $ even w/long stays in N.C. (preliminary; static use)

12. Conclusions/What Next?
More focused audit
Hospice policy change inevitable. What is the goal?
With appropriate comparison, hospice saves Medicare money even with long stays
Could save more (worry unintended conseq)
Some long stay hospice back door LTC
What do patients want?

13. Final Thoughts
The hospice benefit in Medicare has been expected to improve quality & save money since the beginning
A very rare standard in health care
Hospice shouldn’t be the only part of Medicare subjected to such questions