ABCD Exchange : June - July 2000 : Lunch Bunch - Spring Events

Spring Events Focus On Public Television Program and Medicare Reimbursement

"There are big public issues to decide," Moyers said. "But it comes down to local issues." To that end, she and others are encouraging town meetings and similar activities to generate interest and foster change. Local groups are developing resource lists and directories; the PBS website for the program features an ever-expanding directory of resources.

The program has garnered media attention with coverage planned by MSNBC and The Today Show. In September, Modern Maturity will publish a special supplement on end-of-life care. Good Housekeeping will highlight the needs of family caregivers.

"Now that the Boomers are facing their own mortality, and realizing that they will be in charge of caring for their parents, their attention is turning from issues of retirement to issues of mortality," Moyers said.

The special will focus on groups such as the Mt. Sinai Palliative Care Consult program, the Balm of Gilead, Wishard Public Health Services, and several others. "In the shadows of the horrors of death and dying, there are thousands of stories about hospice workers, palliative care specialists, and others. We want to report on models of how things are being changed," Moyers said.

For more information, visit the "On Our Own Terms" website at www.pbs.org/onourownterms.

Group Looks at Recent Hospice Benefit and Usage Research
by David Introcaso, Ph.D.
In June, the ABCD Lunch Bunch learned more about the role the Medicare Hospice Benefit (MHB) plays in contributing to end-of-life care for institutionalized beneficiaries. MEDSTAT’s Barbara Gage, Ph.D. and the Department of Health and Human Services’ Jennie Harvell, M. Ed., presented an overview of recent research sponsored by the DHHS Office of the Assistant Secretary for Planning and Evaluation (ASPE). The study, containing six reports in sum, is available on-line at www.aspe.hhs.gov/daltcp/reports/samhbes.htm. The site provides an executive summary and recommendations from the first report, Synthesis and Analysis of MHB and links to the five others: Important Questions for Hospice in the Next Century; MHB: Use and Expenditures; Use of MHB by Nursing Facility Residents; Outcomes and Utilization of Hospice & Non-Hospice Nursing Facility Decedents; and, Hospice Benefits and Utilization in the Large Employer Market.

The purpose of the study was to provide policymakers with an overview of the MHB, since Medicare pays for nearly four-fifths of all hospice care in the US. The study:

• summarizes discussions with key informants on the use of hospice in nursing homes;

• lists Medicare utilization and payments for hospice users in 1996;

• describes before and after differences in hospice utilization and expenditures when nursing facility residents started using hospice services;

• compares pain management and other services between nursing home residents using hospice and non-hospice users; and,

• describes alternative services provided under 52 employer-sponsored benefit packages.

The project’s claims analysis surveyed three populations: Medicare hospice enrollees; MHB patients in nursing facilities in five states; and, a subset of hospice patients in employer-based or other private plans.

Among its numerous findings, the ASPE research found that the average length of stay was 24 days. Patients with a primary diagnosis of Alzheimer’s disease had the longest lengths of stay (mean of 104 days) and the highest payments per case (mean payment of $9,824). Length of stay varied also greatly by state, as did the percentage of Medicare hospice beneficiaries residing in nursing homes. Length of stay under hospice care in nursing homes was also found to be short, less than 30 days for 50 percent and less than a week for 25 percent. Nevertheless, nursing home residents under hospice care were less likely to have been hospitalized during the last 30 days of life. Also, nursing home patients under hospice received superior pain assessments compared to terminal nursing home patients who did not receive hospice care.

Concerning hospice benefits and utilization in the large employer market, most health plans (88%) of the 52 studies offered a hospice benefit, however, the plans varied widely in configuration. Dr. Gage and Ms. Harvell noted that their research suggested further work in measuring care outcomes for nursing home patients, since many are terminal but few receive hospice. They also highlighted the commensurate need for improved training of nursing home staff in caring for the terminally ill. Regarding payment policies, Gage and Harvell said that there is a need to simplify room and board payment policies for dual-eligible beneficiaries using hospice and residing in nursing facilities.

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