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

As of 2016, a two-tier payment system reduced daily reimbursement rates for hospice patients after 60 days of enrollment, and the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014 standardized audits of extended hospice stays. Both approaches were made in an effort to shorten patients’ hospital stays. Analyze the effects of the new regulations on live discharge rates and the average length of stay. Using Medicare hospice claims from 2008-2019, researchers calculated the monthly percentage of live discharges and an average length of stay at the hospice level. 

Investigators compared hospice care rates before and after policies were enacted for all patients and those with ADRD and lung cancer and by hospice ownership (for-profit vs. nonprofit/government-owned). Analytical samples for live discharge and length of stay analysis totaled 10,539,912 and 10,453,025, respectively. While the monthly proportion of live discharges decreased before regulations were implemented (-0.13 percentage points, 95% CI: -0.14, -0.12), they did not alter significantly afterward. ADRD and lung cancer patients both followed trends driven by for-profit organizations. 

The average length of stay rose with time, but the rate of rise was greater after the implementation of new rules (0.41 days per month, 95% CI: 0.39, 0.42) than it had been before (0.12 days per month, 95% CI: 0.10, 0.14). ADRD patients had a more significant increase in length of stay compared to lung cancer patients. After a steep drop in the number of patients being released from hospitals alive, caused by a shift in the for-profit sector, live discharge rates have leveled out. However, the duration of stay did not decrease and, in fact climbed at quicker rates after the policies were implemented, demonstrating that the increase in excess live discharges was not limited to patients who required longer hospital stays.