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Member Research & Reports

Member Research & Reports

Brown: Service Intensity Add-on Payments Can Increase Hospice In-Person Visits and Reduce Disparities in Visit Patterns in the Last Week of Life

In-person visits by professional hospice staff ensure that the care delivered matches the changing physical and emotional needs of the patient and their family members as death nears. Most hospice care is delivered in the form of routine home care (RHC) at the place of their residence. In 2016, the Centers for Medicare and Medicaid Services (CMS) introduced a Service Intensity Add-on (SIA) payment for in-person RHC visits by a registered nurse or social worker in the last seven days of life.

This study, headed by Dr. Pedro L. Gonzalo, associate professor of health services, policy, and practice, sought to examine visit patterns in the last week of life and provide SIA payment impact estimates. The researchers analyzed a data set with detailed visit data on all patients from 42 different hospice programs across the country during the
2005 – 2010 period. Analyses involved the type and duration of visits/other care, the hospice staff discipline, patient demographics, patient diagnoses, patient date of death, and care setting (home, assisted living, nursing home).

Results indicated that in their last week of life, 251,407 decedents received 2,818,695 visits during RHC days. 44% of the decedents had at least one SIA-eligible visit (in-person direct care visit by a registered nurse or social worker). Rates of RHC days with SIA-eligible days varied considerably across hospices (31% to 60.9%). For the 86.3% decedents with any SIA-eligible visits, the average SIA payment would have been $202.5, which represents a 21.6% increase over the average regular RHC payments received during the last week of life.

Ultimately, the size of the SIA payment incentive, together with the large disparity in SIA-eligible hours observed across hospice programs, has the important implication that while the SIA will incentivize all providers to increase the number of registered nurse and social worker visits during the last week of life, the incentive will be particularly strong for programs currently delivering at the low end of SIA-eligible minutes. This is the first study to examine the potential impact of SIA payments overall and to illustrate the large variability across hospice programs. It therefore provides an important benchmark to put in perspective the importance of the SIA incentive.

This study was published this June in Journal of Palliative Medicine.

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