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MedPAC payment recs call for more accountability
The Medicare Payment Advisory Commission (MedPAC) recommendations to Congress for the reformation of the Medicare hospice benefit include strategies to remove incentives for long hospice lengths of stay, to improve oversight of hospice services and payments, and to improve data collection to facilitate better management of the hospice benefit.
Specific recommendations include:
relatively higher payments per day at the beginning of the episode and relatively lower payments as the length of the episode increases;
relatively higher payment for the costs associated with patient death at the end of the episode;
physician or advanced practice nurse visits to the patient to determine continued eligibility prior to the 180th-day recertification and each subsequent recertification;
medical review of all stays in excess of 180 days for hospices for which stays exceeding 180 days make up 40% or more of their total cases;
investigation by the Office of the Inspector General (OIG) of the financial relationships between hospices and long-term care facilities;
OIG investigation of marketing materials and admissions practices, and correlation between those items and lengths of stay.
To see a copy of the full report, go to www.medpac.gov/documents/Mar09_EntireReport.pdf.