Hospice Visit Patterns in the Last Seven Days of Life and the Service Intensity Add-On Payment

J Palliat Med. 2017 Dec;20(12):1378-1384. doi: 10.1089/jpm.2017.0214. Epub 2017 Jun 16.


Background: Hospice in-person visits in the last week of life are critical to ensure quality of care. In 2016, The Centers for Medicare & Medicaid Services (CMS) introduced a Service Intensity Add-on (SIA) payment for in-person routine home care (RHC) visits by a registered nurse or social worker in the last 7 days of life.

Objectives: The aim of the study was to examine visit patterns in the last week of life and provide SIA payment impact estimates.

Design/measurements: Hospice data from 42 volunteer hospice programs for the 6-year period of 2005-2010 were examined. The data included information on the type and duration of visits/other care, the staff discipline, and patient demographics, diagnoses, date of death, and care setting (home, assisted living, nursing home).

Results: In their last week of life, 251,407 decedents received 2,818,695 visits during 1,352,638 RHC days. Forty-four percent of the decedents had at least one SIA-eligible visit (in-person direct care visit by a registered nurse (RN) or social worker (SW)); 6.6% had only phone contact, and 30.4% had no hospice contact. 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, average SIA payment would have been $202.5 (Median = $177.2, inter quartile range [IQR] = $108.3-$275.6), which represents a 21.6% increase over the average regular RHC payments received during the last week of life.

Conclusions: The relative size of the new SIA payment introduced by CMS has the potential to increase RN/SW visits and reduce disparities in visit patterns in the last week of life.

Keywords: hospice care payment; hospice visit patterns; medicare hospice benefit.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Child
  • Child, Preschool
  • Female
  • Health Expenditures / statistics & numerical data*
  • Home Care Services / economics*
  • Home Care Services / statistics & numerical data
  • Hospice Care / economics*
  • Hospice Care / statistics & numerical data
  • House Calls / economics*
  • House Calls / statistics & numerical data
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Medicare / statistics & numerical data*
  • Middle Aged
  • Nursing Homes / economics*
  • Nursing Homes / statistics & numerical data
  • Retrospective Studies
  • Terminal Care / economics*
  • United States
  • Young Adult