Medicare Hospice Care: Modifications to Payment Methodology May Be Warranted;Report to the Congress

摘要

The Medicare hospice benefit provides care to patients with a terminal illness. For each patient, hospices are paid a per diem rate corresponding to one of four payment categories, which are based on service intensity and location of care. Since implementation in 1983, the payment methodology and rates have not been evaluated. The Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999 directed GAO to study the feasibility and advisability of updating Medicare's payment rates for hospice care. In this report, GAO (1) compares freestanding hospices' costs to Medicare payment rates and (2) evaluates the appropriateness of the per diem payment methodology. Because of Medicare data limitations, it was not possible to compare actual payments to costs or examine the services provided to each patient. GAO recommends that the Administrator of the Centers for Medicare & Medicaid Services (CMS) collect comprehensive, patient-specific utilization and cost data on hospice visits and services, and using these data, determine whether modifications to the payment methodology are needed, including any adjustments needed for small providers. CMS stated that it agreed with GAO's recommendations.