The Medicare Payment and Advisory Commission (MedPAC) met in early November 2009 to discuss, among other topics, hospice visit patterns. Even though the hospice visit patterns identified by MedPAC were somewhat limited due to available visit data, the data collected continues to support MedPAC's previous recommendation to reform the hospice Medicare benefit (HMB) and adjust hospice payments based on the length of stay rather than the current flat per diem rate.

As you may recall, MedPAC submitted a report to Congress in March 2009, which highlighted a concern that the HMB contains an incentive for hospice providers to promote long hospice stays rather than focus on the appropriate timing of admissions, as demonstrated by a “strong correlation between the length of stay and profitability.” MedPAC noted that the average length of stay for hospice patients increased from 62 days in 2000 to 82 days in 2006. Hospice stays at the 90th percentile of distribution increased from 144 days in 2000 to 212 days in 2005, and declined in this same time period for stays at or below the median length of stay. Therefore, according to the hearing transcript, only the long lengths of stay are getting longer.

In light of this concern, MedPAC made several recommendations, including that Congress should direct the Secretary of the Department of Health and Human Services to change the Medicare payment system for hospices to:

Based on the recent visit data presented by MedPAC, all indications are that MedPAC will continue to recommend hospice payment reform in a manner similar, if not identical, to its earlier recommendations. MedPAC's recent findings include:

MedPAC concludes by acknowledging that its analysis confirms its earlier findings and continues to support the need for hospice payment reform, and further indicates that additional research steps may include additional analysis of claims data, proprietary data on travel time by patient location, and proprietary data on other hospice costs, including prescription drug and durable medical equipment use.

Since hospice payment reform seems to be inevitable and will likely be based at least in part on length of stay, you should audit your own visit and length-of-stay patterns to identify potential problematic areas. MedPAC also met on December 10, 2009, to discuss hospices' payment adequacy. More about that meeting and its findings will be available in next month's Hospice EndNotes.

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