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Early Impacts of COVID-19 on the Utilization of the Medicare Hospice Benefit (SCI911)

      Objectives

      • 1.
        Describe the prevalence of COVID-19 amongst Medicare Hospice beneficiaries.
      • 2.
        Describe changes in utilization of the Medicare hospice benefit (as measured through visits and live discharge rates) during the Public Health Emergency (PHE) compared to before the PHE.

      Background

      The COVID-19 Public Health Emergency (PHE) has substantially impacted the utilization of healthcare services. Due to the mortality rate associated with COVID-19 in elderly patients, COVID-19 may have a profound impact on hospice users. Abt Associates is working with the Centers for Medicare & Medicaid Services Chronic Care Policy Group to monitor the impact of COVID-19 amongst hospice users.

      Research Objectives

      Within this presentation, we describe how Medicare beneficiaries have utilized the Medicare Hospice Benefit (MHB) during the early months of the PHE and how that compares to the utilization of the MHB prior to the PHE.

      Methods

      We examined Part A and Part B Fee-for-Service (FFS) Medicare claims from January 1, 2019–May 31, 2020. We identified the presence of COVID-19 based on the presence of ICD-10 codes.

      Results

      As of May 31, 2020, we identified approximately 39.0 million unique FFS beneficiaries in 2020, 2.0% of which had at least one hospice claim during 2020. Although the overall rates of hospice utilization amongst patients with COVID-19 is relatively low (1.8%), there is substantial state-level variation (e.g., 8.2% in Massachusetts and 0.3% in Tennessee). Average per-beneficiary per-month hospice visits under MHB have fallen from April 2019 (7.4 aide visits, 6.6 skilled nursing visits) to April 2020 (4.7 aide visits, 5.0 skilled nursing visits), which indicates that COVID-19 may have had an impact on the number of in-person visits. Live discharge rates have also fallen slightly between FY2019 and FY2020 (17.5% to 15.8%).

      Conclusion

      There have been noticeable changes in the number of visits and live discharge rates during the PHE compared to before the PHE.

      Implications for Research, Policy, or Practice

      CMS should continue to monitor rates of COVID-19 amongst hospice users and measures of hospice utilization (visits, live discharge) in order to better understand how the PHE impacts the provision of the Medicare Hospice Benefit.