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Transcript for audio podcast on the following report: Medicare Hospices That Focus on Nursing Facility Residents.

From the Office of Inspector General of Department of Health & Human Services

Roberta Baskin, Director of Media Communications, sits down with Jodi Nudelman, Regional Inspector General for the Office of Evaluations and Inspections (OEI) in New York, to discuss the OEI report titled Medicare Hospices That Focus on Nursing Facility Residents.

Released July 19, 2011

[Roberta Baskin:] I'm Roberta Baskin, the Director of Media Communications, speaking with Jodi Nudelman, a Regional Inspector General for the Office of Evaluations and Inspection in our first podcast, and it's about a report called Medicare Hospices That Focus on Nursing Facility Residents. Jodi, can you just describe Medicare's hospice benefit and how it works?

[Jodi Nudelman:] Sure. Hospice care is intended to help beneficiaries in their last months of life. It also supports their families, and other caregivers. Now, to be eligible for Medicare hospice care, a beneficiary must have a terminal illness and have a life expectancy of six months or less. So we typically think of providing hospice in a home, but it actually can be provided in other settings, such as a nursing facility.

[Roberta Baskin:] There have been quite a few changes to the Medicare hospice benefit in recent years. Can you just describe those changes?

[Jodi Nudelman:] Hospice care overall has grown significantly, but we've seen high growth particularly in hospice care in nursing facilities. So just to give you an example, Medicare spending for such care has risen nearly 70% since 2005. This is much faster than spending for hospice care in other settings.

[Roberta Baskin:] In light of these changes, what areas has the Office of the Inspector General identified as the major causes of concern?

[Jodi Nudelman:] Well, one of our biggest concerns is that many hospices that serve beneficiaries in nursing facilities are providing services that are just not meeting basic Medicare requirements. In fact, we found 82% of claims from these hospices do not meet Medicare standards. So in some cases, for example, these hospices aren't providing all the services the beneficiaries need.

[Roberta Baskin:] And what else did you find?

[Jodi Nudelman:] Another big concern is that certain hospices seem to be seeking out beneficiaries with particular characteristics, and these beneficiaries are often found in nursing facilities. In our most recent work, we identified hundreds of hospices that have a high-percentage of their beneficiaries in nursing facilities.

[Roberta Baskin:] What exactly are high-percentage hospices, and how do they differ from other hospices?

[Jodi Nudelman:] Well we define high-percentage hospices as hospices that have more than two-thirds of their beneficiaries in nursing facilities. And our analysis showed that these hospices and their beneficiaries look quite different from other hospices. So, for example, high-percentage hospices are much more likely to be for profit. They are also more likely to enroll beneficiaries who spend more time in hospices and have conditions that require less complex care.

[Roberta Baskin:] Why should we be concerned about high-percentage hospices?

[Jodi Nudelman:] Well high-percentage hospices bill Medicare much more per beneficiary than other hospices do. In fact, Medicare paid these hospices over $3,000 more per beneficiary on average than it paid other hospices. Additionally, our prior work has found that hospices provided an average of just four services per week for beneficiaries in nursing facilities. And many of these services were similar to the services that nursing facilities already are being paid for. That said, we're concerned that the current payment structure provides incentives for hospices to seek out beneficiaries in nursing facilities.

[Roberta Baskin:] Well the agency responsible for Medicare is known as CMS and what is the Office of Inspector General recommending how they address this?

[Jodi Nudelman:] We recommended two things for CMS to do. First, to reduce Medicare payments for hospice care in nursing facilities. CMS agreed with the recommendation and they are already in the early stages of reforming the payment structure. We also recommended that CMS monitor hospices that depend heavily on these nursing facility residents and CMS agreed with this recommendation as well.

[Roberta Baskin:] Can you look ahead and tell us what additional areas of concern The Office of Inspector General plans to look at in the future?

[Jodi Nudelman:] Well this report is part of a much larger body of work and we're going to focus on a number of things. One upcoming report will assess the business relationships between the high-percentage hospices and the nursing facilities that they're associated with. Another report will look at the marketing practices of hospices. And our goal with this work is really to help save tax-payer dollars but more importantly ensure that Medicare beneficiaries get the care that they need and deserve in the last months of their lives.

[Roberta Baskin:] Thank you Jodi Nudelman, a Regional Inspector General for the Office of Evaluation and Inspections for sharing this important work on hospices.

[Jodi Nudelman:] Thank you.


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