Hospice Visit Intensity by Physicians and Nurse Practitioners on the General Inpatient Level of Care (TH371C)

Abstract

•Describe the rate of physician or nurse practitioner services during GIP service.•Describe episode characteristics associated with the rate of physician or nurse practitioner services during GIP service. The Medicare Hospice Benefit’s General Inpatient (GIP) level of care is intended to provide for pain and symptom management in an inpatient facility that could not be managed in the patient’s home. Examine how beneficiaries utilize physician and nurse practitioner services while receiving GIP care. Retrospective cohort analysis of Medicare hospice beneficiaries utilizing GIP during Federal Fiscal Year 2014 (FY2014). Using 100% Medicare hospice and Part B claims from FY2014 we examined physician and nurse practitioner service visit intensity during GIP. We found that among the 1.5 million GIP days serviced in FY2014, the majority of days (52.4%) were not associated with any recorded physician or nurse practitioner services. Rates of the absence of these services were particularly high among hospice GIP days provided in (Acute) Inpatient Facilities (69.1% of days missing physician/nurse practitioner services), Long-Term Care Hospitals (84.3% missing services), and Skilled Nursing Facilities (85.3% missing services). Moreover, one in five hospice episodes that have at least three days of sequential GIP care did not have any physician or nurse practitioner services recorded from either the hospice or Part B claims; this was true for more than half of such episodes beginning in long-term care hospitals or skilled nursing facilities. We found that over two-thirds of all GIP days are serviced in hospice inpatient units and that cancer was the most common primary hospice diagnosis at admission among GIP days. GIP is an important component of the hospice benefit and these findings underscore a recent Office of Inspector General report finding variation in the utilization of GIP.