Does Medicare/Medicaid incentive payment affect home hospice care in last week of life?

A new study has shown that the new Service Intensity Add-on (SIA) payment for in-person routine home hospice care during the last 7 days of life, which was added to Medicare/Medicaid coverage in 2016, could increase visits by registered nurses or social workers during a patient's last week of life. The number of visits, estimated SIA payments, and potential for this incentive to reduce disparities in end-of-life hospice care are discussed in an article published in Journal of Palliative Medicine.

Pedro Gozalo, PhD, Brown University School of Public Health (Providence, RI), Joan Teno, MD, University of Washington (Seattle), and Carol Spence, PhD, National Hospice and Palliative Care Organization (Alexandria, VA) coauthored the article entitled "Hospice Visit Patterns in the Last Seven Days of Life and the Service Intensity Add-On Payment."

The authors analyzed data from 42 volunteer hospice programs over the 6-year period 2005-2010, encompassing more than 250,000 patients and 2.8 million visits. The average SIA payment for the more than 86% of patients reported to have had an SIA-eligible visit would have been $202.50. This is a 21.6% increase over the average regular routine home care payments received during the last 7 days of life.

"More people will get the expert assistance they need in the last days of life because of this research," says Charles F. von Gunten, MD, PhD, Editor-in-Chief of Journal of Palliative Medicine and Vice President, Medical Affairs, Hospice and Palliative Medicine for the OhioHealth system.