Abstract
Context
The 2014 Improving Medicare Post-Acute Care Transformation (IMPACT) Act systemized
audits of long hospice stays, and the 2016 two-tier payment system decreased daily
reimbursement rates after 60 days of enrollment. Both aimed to reduce long stays.
Objectives
Examine how live discharge rates and length of stay changed in relation to the policies.
Methods
We computed monthly hospice-level percent live discharges and length of stay using
2008−2019 Medicare hospice claims. We compared prepolicies trends and postpolicies
trends overall, within Alzheimer's disease and related dementias (ADRD) patients,
within lung cancer patients, and stratified by hospice ownership (for-profit vs. nonprofit/government-owned).
Results
We included 10,539,912 and 10,453,025 episodes of care in the analytical samples for
live discharge and length of stay analyses, respectively. Overall percent live discharges
declined during the prepolicies period (-0.13 percentage-points per month, 95% CI:
-0.14, -0.12), but exhibited no significant change during the postpolicies period.
Trends were driven primarily by for-profits, with similar patterns within ADRD and
lung cancer patients. Overall, mean length of stay increased over time, with greater
rate of increase during the postpolicies period (0.41 days per month, 95% CI: 0.39,
0.42) compared to the prepolicies period (0.12 days per month, 95% CI: 0.10, 0.14).
Length-of-stay increased faster among ADRD patients, but changed minimally for lung
cancer patients.
Conclusion
Live discharge rates declined significantly during the prepolicies period, but plateaued
after implementation of the policies, driven by changes in for-profits. However, the
policies did not reduce length of stay, which increased at faster rates, suggesting
that postpolicies excess live discharges were not restricted to long-stay patients.
Key Words
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Article info
Publication history
Published online: December 13, 2022
Accepted:
December 5,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
