The Medicare payment rule that disallows residents at the end of life to receive concurrent skilled nursing and hospice benefits can lead to aggressive and unwanted end-stage treatments for residents, according to a new study published in the Journal of the American Geriatrics Society.
Researchers tracked 4,344 nursing home residents with advanced dementia to see how they had fared under the Medicare policy. Residents who used hospice services either during or after their skilled care were less likely to die in the hospital than those residents who did not receive hospice. Data also indicated that residents in the hospice setting received fewer treatments, medicines (excluding anti-anxiety and hypnotic drugs), intravenous fluids or therapies.
But the study also showed that fewer (30 percent) residents with advanced dementia in the skilled care setting used hospice as compared to those residents (46 percent) who did not have Medicare skilled nursing care.
Medicare policy disallows simultaneous reimbursement for skilled nursing and hospice because each type of care is focused on a different medical goal. But the inability to claim dual reimbursements may be forcing families to choose the higher reimbursement rates of skilled nursing when hospice care would be the more appropriate option, researchers noted.
“Unfortunately, given the high use of Medicare skilled nursing care near the end of life and policy that prevents simultaneous Medicare reimbursement for skilled care and hospice, aggressive treatments that may not be the preference of families or their loved ones are common,” wrote Susan Miller, professor of health services policy and practice at Brown University and lead researcher of the study.
This issue will be further investigated through the Medicare Hospice Concurrent Care demonstration project, as mandated by the Affordable Care Act.