The following is a summary of “Medicare Hospice Policy Changes and Beneficiaries’ Rate of Live Discharge and Length-of-Stay,” published in the MARCH 2023 issue of Pain Management by Gianattasio, et al.

After 60 days of participation, the daily reimbursement rates were reduced under the 2016 two-tier payment system and the 2014 Improving Medicare Post-Acute Care Transformation (IMPACT) Act, which systematized audits of prolonged hospice stays. For a study, researchers sought to cut down on extended stays and analyze how the policies affected the length of stay and live discharge rates.

With the help of Medicare hospice claims from 2008 through 2019, they calculated the monthly percent of live discharges and length of stay. Overall, among patients with lung cancer, Alzheimer’s disease, and related dementias (ADRD), and stratified by hospice ownership (for-profit vs. nonprofit/government-owned), they compared pre policies trends with post policies trends.

For the length of stay and live discharge analyses, respectively, they included 10,539,912 and 10,453,025 episodes of care in the analytical samples. Although the overall percent of live discharges decreased during the prepolicies period (-0.13 percentage points per month, 95% CI: -0.14, -0.12), the postpolicies period showed no discernible change. With comparable tendencies among ADRD and lung cancer patients, for-profit businesses predominantly drove trends. In general, the average length of stay grew over time, albeit at a faster rate in the post-policies period (0.41 days per month, 95% CI: 0.39, 0.42) than in the pre-policies period (0.12 days per month, 95% CI: 0.10, 0.14). Compared to lung cancer patients, ADRD patients’ length of stay increased more quickly.

Live discharge rates considerably decreased before the implementation of the regulations, but they plateaued afterward due to changes in the for-profit sector. However, the policies did not shorten hospital stays, which grew at quicker rates, indicating that post-policies excess live discharges were not only given to patients who stayed in hospitals for a lengthy time.