Surgery Without a Surrogate: The Low Prevalence of Healthcare Power of Attorney Documents Among Pre-Operative Patients Requiring General Anesthesia (S755)

Abstract

different quality measures: (1) rate of not providing skilled visits at the end of life (2) average length of stay (ALOS), (3) live discharge rates, (4) general inpatient (GIP) care days, and (5) nursing minutes provided per day. Methods. Quality measures are calculated using 100% of Medicare hospice claims from January 1, 2010 through January 31, 2013. For each measure, hospices are grouped into deciles. An overall count of how many times a hospice appears in the eighth decile or higher is made to determine which hospices are outliers. Results. There are 14 hospices that are in the highest three deciles for the first three measures and the lowest three deciles for the last two measures. 226 hospices are in the worst three deciles for at least four measures. The majority of those hospices (70.8%) are located in the south census region, and 80.4% are for-profit providers. The average spending per beneficiary for those hospices is $25,518, compared to $14,977 per beneficiary for all hospices. Conclusion. Using this data, CMS and MACs can identify hospices that are outliers for a given measure. Not all outliers indicate a serious problem, however if a hospice is an outlier for several measures, it may indicate questionable practices and a need for closer inspection by CMS and MAC. Implications for Research, Policy or Practice. Hospices should monitor their outcomes along the measures discussed to understand how they perform compared to their peers.