Medicare Hospice: Use of General Inpatient Care

WHY WE DID THIS STUDY

Hospice general inpatient care (GIP) is for pain control or symptom management provided in an inpatient facility that cannot be managed in other settings. The care is intended to be short-term and is the second most expensive level of hospice care. GIP may be provided in one of three settings: a Medicare-certified hospice inpatient unit, a hospital, or a skilled nursing facility (SNF). CMS staff have expressed concerns about possible misuse of GIP, such as care being billed for but not provided, long lengths of stay, and beneficiaries receiving care unnecessarily.

HOW WE DID THIS STUDY

We based this memorandum report on an analysis of Medicare Part A hospice claims. We analyzed the claims data to identify the hospice beneficiaries who received GIP during 2011, the number of days that each beneficiary received this care, and the setting in which the care was provided. We also determined from the claims data the terminal illness of each beneficiary. In addition, we identified all of the Medicare-certified hospices that provided hospice care in 2011.

WHAT WE FOUND

We found that Medicare paid $1.1 billion for GIP in 2011, most of which was provided in hospice inpatient units, as opposed to hospitals or SNFs. Twenty-three percent of Medicare hospice beneficiaries received GIP during the year. One-third of beneficiaries' GIP stays exceeded 5 days, with 11 percent lasting 10 days or more. The hospices that used inpatient units provided GIP to more of their beneficiaries and for longer periods of time than hospices that used other settings. We also found that 953 hospices, or 27 percent of Medicare hospices, did not provide any GIP to Medicare beneficiaries in 2011 and that 429 of these hospices did not provide any level of hospice care other than routine home care.

These results raise several questions about GIP. Long lengths of stay and the use of GIP in inpatient units need further review to ensure that hospices are using GIP as intended and providing the appropriate level of care. Also, CMS should focus on hospices that do not provide GIP and ensure that these hospices are providing beneficiaries access to needed levels of care at the end of their lives. One option is for CMS to adopt a quality measure regarding hospices' ability to provide all hospice services.

This report does not contain recommendations.