Earlier Hospice Election Could Save Medicare $1.5B Yearly

Published by Hospice News

By Jim Parker

Medicare could save between $1.19 billion and $1.5 billion annually if eligible beneficiaries elected the hospice benefit five days earlier, according to a new analysis commissioned by the Research Institute for Home Care.

The project’s Early Hospice Election Model examined Medicare beneficiaries who entered hospice care within eight weeks of death. Drawing on data from rigorous, peer-reviewed studies conducted between 2002 and 2018, researchers found that consistently earlier hospice enrollment produces incremental daily savings that accumulate over time.

The consulting firm ATI Advisory conducted the analysis on behalf of the Research Institute for Home Care, which is an affiliate of the National Alliance for Care at Home.

“The Medicare Hospice Benefit is one of the greatest successes in the American health care system. It has allowed the most vulnerable Americans to access patient-, person- and family-centered holistic care, to quality care,” Logan Hoover, vice president of policy and government relations of the National Alliance for Care at Home, said during a webinar announcing the results. “It supports families, patients, caregivers and communities through the most difficult times in life. This research reaffirms that value, despite being designed and implemented 40 years ago, is really the best example of a value-based payment system that works.”

For the analysis, researchers first carried out a comprehensive literature review of relevant studies that looked at the relationship between the timing of when individuals go into hospice, and the impact on healthcare utilization and health care spending, Fred Bentley, managing director of ATI Advisory, said during the webinar.

Secondly, they conducted an evidence synthesis to identify which of those studies had the strongest evidence base. ATI then built a complex model to determine what would happen if Medicare beneficiaries elected hospice five days earlier than many do now.

“As modeled, the evidence suggests a modest shift in hospice timing among people who already use the benefit may be associated with significant system level savings, in addition to the person centered goals that hospice was designed to serve,” Nils Franco, director at ATI Advisory, said in a Zoom call.

Hospice election generates savings by reducing the incidence of intensive medical and surgical interventions at the end of life, according to Alex Hartman, head of operations for the Research Institute for Home Care and vice president for research and analytics at the Alliance. Patients who elect hospice experience fewer hospitalizations and emergency department visits, he said.

To foster earlier access to hospice, the provider community must engage in public education to build greater awareness and understanding of the benefit, as well as palliative care, Hoover said. Benefit reforms such as allowing a limited amount of concurrent curative services could also make a difference, as would greater workforce development and specific hospice and palliative care training.

“Timely hospice care not only represents the preferred choice for patients and families, but also presents sound fiscal policy,” said Jennifer Sheets, CEO for the Alliance and president of the institute, said in a statement. “The potential savings identified in this report are further evidence of the additional value hospice can add to the Medicare program while ensuring more compassionate, person-centered care is provided for Americans at the end of life.”

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