How the Medicare Shared Savings Program ACO Model Affects Hospice Utilization (FR440A)

Driessen, Julia; West, Turner

doi:10.1016/j.jpainsymman.2017.12.118

Cited by 1 publication

(2 citation statements)

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“…The timing of hospice enrollment is critical because benefits of hospice services may not be fully realized when hospice enrollment occurs within 7 days of death, due to the short duration . Similar to prior evidence in decedents, length of hospice use did not increase by MSSP status for high‐risk patients in this study, potentially because survival following stroke was too brief for providers to influence the outcome …”

Section: Discussionsupporting

confidence: 71%

“…Relative to the larger Medicare population, our cohort of ischemic stroke patients has a much higher postdischarge mortality risk and therefore greater rate of hospice enrollment. Our study cohort is more comparable with Medicare decedents, where increases in hospice enrollment were associated with MSSP . The timing of hospice enrollment is critical because benefits of hospice services may not be fully realized when hospice enrollment occurs within 7 days of death, due to the short duration .…”

Section: Discussionmentioning

confidence: 92%

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Medicare Shared Savings ACOs and Hospice Care for Ischemic Stroke Patients

Kaufman

O’Brien

Stearns

et al. 2019

J American Geriatrics Society

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OBJECTIVES Palliative care services have the potential to improve the quality of end‐of‐life care and reduce cost. Services such as the Medicare hospice benefit, however, are often underutilized among stroke patients with a poor prognosis. We tested the hypothesis that the Medicare Shared Savings Program (MSSP) is associated with increased hospice enrollment and inpatient comfort measures only among incident ischemic stroke patients with a high mortality risk. DESIGN A difference‐in‐differences design was used to compare outcomes before and after hospital participation in the MSSP for patients discharged from MSSP hospitals (N = 273) vs non‐MSSP hospitals (N = 1490). SETTING Records from a national registry, Get with the Guidelines (GWTG)‐Stroke, were linked to Medicare hospice claims (2010‐2015). PARTICIPANTS Fee‐for‐service Medicare beneficiaries age 65 and older hospitalized for incident ischemic stroke at a GWTG‐Stroke hospital from January 2010 to December 2014 (N = 324 959). INTERVENTION Discharge from an MSSP hospital or beneficiary alignment with an MSSP Accountable Care Organization (ACO). MEASUREMENTS Hospice enrollment in the year following stroke. RESULTS Among patients with high mortality risk, ACO alignment was associated with a 16% increase in odds of hospice enrollment (adjusted odds ratio [OR] = 1.16; 95% confidence interval [CI] = 1.06‐1.26), increasing the probability of hospice enrollment from 20% to 22%. In the low mortality risk group, discharge from an MSSP vs non‐MSSP hospital was associated with a decrease in the predicted probability of inpatient comfort measures or discharge to hospice from 9% to 8% (OR = .82; CI = .74‐.91), and ACO alignment was associated with reduced odds of a short stay (<7 days) (OR = .86; CI = .77‐.96). CONCLUSION Among ischemic stroke patients with severe stroke or indicators of high mortality risk, MSSP was associated with increased hospice enrollment. MSSP contract incentives may motivate improved end‐of‐life care among the subgroups most likely to benefit.

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Section: Discussionsupporting

confidence: 71%

Section: Discussionmentioning

confidence: 92%