Pediatric Concurrent Hospice Care: Cost Implications of a Hybrid Payment Model

Abstract

Background: Implementation of concurrent hospice care led to a new hybrid payment model that combines hospice payments with payments for non-hospice medical care. Little is known about the cost implications of this new hybrid payment model. Objective: The purpose was to identify costs and compare concurrent care and standard hospice care costs by estimating the average incremental Medicaid cost of care over time. Methods: Using national Medicaid data of 18 147 hospice children and a multilevel generalized linear model, we calculated the incremental costs of receiving concurrent vs standard hospice care. We used the total cost of care over the last year of life. Increments for the analysis were hospice length of stay, stratified to 1 day, 2-14 days, and 15 + days. Results: Overall, compared to standard hospice care, enrollment in concurrent hospice care was significantly associated with an increase in outpatient care and prescription drug costs. For a stay of 1 day, concurrent hospice care decreased inpatient costs and increased costs of prescription drugs. For stays between 2 and 14 days, concurrent hospice decreased total costs and inpatient costs, but increased prescription drug costs. With a hospice stay of 15 + days, concurrent hospice had significantly higher costs across all measures, including total costs, inpatient costs, outpatient costs, and prescription drug costs. Conclusion: This study provides critical insight into incremental costs of receiving concurrent vs standard hospice care. More research is needed to understand how concurrent hospice lengthy hospice stays are associated with increases of costs.

Incremental cost analysis of pediatric hospice care in rural and urban Appalachia

“…For hospice stays of 15 days or more, this study showed that enrollment in concurrent care was associated with a significant increase in Medicaid costs compared to standard hospice care in Appalachia. This result mirrors findings from the previous study 26 . However, the current report also found that although the unadjusted Medicaid costs of concurrent care were higher in rural areas than in urban when controlled for patients' demographic and health conditions, the costs were lesser in rural areas than in urban.…”

“…LOS measured the total number of days enrolled in hospice care. It was stratified into 3 time intervals: 1 day, 2‐14 days, and 15 days or more 26 …”

Conceptualizing the Value of Pediatric Concurrent Hospice Care

“…23 However, there is an interesting and unique cost profile that emerges based on the number of days children are enrolled in hospice care. 23 Compared with standard hospice care, children receiving concurrent care had significantly lower total costs and inpatient costs with a hospice length of stay of 14 days or less. At a length of hospice stay of 15 days or more, concurrent care demonstrated significantly higher costs across all measures: total costs, inpatient costs, outpatient costs, and prescription costs.…”

“…It considers the costs concerning the clinical benefits by comparing 1 service (eg, concurrent hospice care) to another service (eg, standard hospice care) 15 . By definition, the costs (eg, total costs, inpatient costs, outpatient costs, prescription costs) of concurrent hospice care will be higher than standard hospice care because in standard hospice care, patients waive any medical care services 23 . However, there is an interesting and unique cost profile that emerges based on the number of days children are enrolled in hospice care 23 .…”

“…Medicaid incurred higher costs for children receiving concurrent hospice care. Cozad et al 23 found that the total Medicaid costs were $6371 per patient per month (PPPM) for children in concurrent care versus $4545 PPPM for standard hospice care. This trend was also present in inpatient care, outpatient care, and medication costs.…”