Evaluation of Federal Policy Changes to the Hospice Benefit and Use of Hospice for Persons With ADRD

Abstract

Key Points Question Did hospice use for persons with Alzheimer disease and related dementias (ADRD) change between 2008 and 2019 in conjunction with Medicare policy changes that aimed to reduce long hospice stays? Findings In this cross-sectional study of Medicare claims data from 11 124 992 unique hospice episodes, there were immediate declines in the share of patients receiving hospice care with ADRD and a slower growth in use of hospice care among patients with ADRD after implementation of the US Improving Medicare Post-Acute Care Transformation Act and the 2-tier payment system compared with prepolicy trends. Meaning The study results suggest that reduced utilization of hospice by patients with ADRD following these policy changes may be negatively associated with end-of-life experience and outcomes for persons with ADRD.

Dying or Lying? For-Profit Hospices and End of Life Care

“…In 2016, CMS increased the routine home care per diem payment for the first 60 days and last 7 days (for decedents) of an episode and lowered the payment for the intervening period. A timeseries study (Gianattasio, Ali, Lupu, Prather, & Power, 2022) found that, after 2014, the proportion of patients admitted with an ADRD diagnosis initially declined but then increased, suggesting that hospices may have initially overestimated the stringency or intensity of audits.…”