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Medicare Hospice Policy Changes and Beneficiaries' Rate of Live Discharge and Length-of-Stay
Gianattasio Kan Z, Power Melinda C, Lupu Dale, Prather Christina, Moghtaderi Ali. Journal of pain and symptom management, 2022-12-17
Topic: Risk, prevention and care in population studies
Plain-language summary
The 2014 Improving Medicare Post-Acute Care Transformation (IMPACT) Act systemized audits of long hospice stays, and the 2016 two-tier payment system decreased daily reimbursement rates after 60 days of enrollment. Both aimed to reduce long stays. Examine how live discharge rates and length of stay changed in relation to the policies. We computed monthly hospice-level percent live discharges and length of stay using 2008-2019 Medicare hospice claims. We compared prepolicies trends and postpolicies trends overall, within Alzheimer's disease and related dementias (ADRD) patients, within lung cancer patients, and stratified by hospice ownership (for-profit vs. nonprofit/government-owned). We included 10,539,912 and 10,453,025 episodes of care in the analytical samples for live discharge and length of stay analyses, respectively. Overall percent live discharges declined during the prepolicies period (-0.13 percentage-points per month, 95% CI: -0.14, -0.12), but exhibited no significant change during the postpolicies period. Trends were driven primarily by for-profits, with similar patterns within ADRD and lung cancer patients. Overall, mean length of stay increased over time, with greater rate of increase during the postpolicies period (0.41 days per month, 95% CI: 0.39, 0.42) compared to the prepolicies period (0.12 days per month, 95% CI: 0.10, 0.14). Length-of-stay increased faster among ADRD patients, but changed minimally for lung cancer patients. Live discharge rates declined significantly during the prepolicies period, but plateaued after implementation of the policies, driven by changes in for-profits. However, the policies did not reduce length of stay, which increased at faster rates, suggesting that postpolicies excess live discharges were not restricted to long-stay patients.
What this study adds
Evidence grade: Low
This study examined how Medicare hospice policy changes related to live discharge rates and length of stay, including among patients with Alzheimer's disease and related dementias. It is about hospice payment policy, not about treating, curing, or preventing Alzheimer's disease.
Taken from this record’s own fields, not from reading the paper. The grade is assigned from the abstract’s wording; what that means.
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
APA 7th
Gianattasio Kan, Z., Power Melinda, C., Dale, L., Christina, P., & Ali, M. (2023). Medicare Hospice Policy Changes and Beneficiaries' Rate of Live Discharge and Length-of-Stay. Journal of pain and symptom management. https://doi.org/10.1016/j.jpainsymman.2022.12.001
Vancouver
Gianattasio Kan Z, Power Melinda C, Dale L, Christina P, Ali M. Medicare Hospice Policy Changes and Beneficiaries' Rate of Live Discharge and Length-of-Stay. Journal of pain and symptom management. 2023. doi:10.1016/j.jpainsymman.2022.12.001. PMID: 36526252.
BibTeX
@article{gianattasiokan2023-36526252,
author = {Gianattasio Kan, Z. and Power Melinda, C. and Dale, Lupu and Christina, Prather and Ali, Moghtaderi},
title = {{Medicare Hospice Policy Changes and Beneficiaries' Rate of Live Discharge and Length-of-Stay}},
journal = {Journal of pain and symptom management},
year = {2023},
doi = {10.1016/j.jpainsymman.2022.12.001},
pmid = {36526252},
url = {https://doi.org/10.1016/j.jpainsymman.2022.12.001}
}
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. Check the citation against the original before you use it.
Key findings
- We compared prepolicies trends and postpolicies trends overall, within Alzheimer's disease and related dementias (ADRD) patients, within lung cancer patients, and stratified by hospice ownership (for-profit vs. nonprofit/government-owned).
- Overall percent live discharges declined during the prepolicies period (-0.13 percentage-points per month, 95% CI: -0.14, -0.12), but exhibited no significant change during the postpolicies period.
- Overall, mean length of stay increased over time, with greater rate of increase during the postpolicies period (0.41 days per month, 95% CI: 0.39, 0.42) compared to the prepolicies period (0.12 days per month, 95% CI: 0.10, 0.14).
- Live discharge rates declined significantly during the prepolicies period, but plateaued after implementation of the policies, driven by changes in for-profits.
- However, the policies did not reduce length of stay, which increased at faster rates, suggesting that postpolicies excess live discharges were not restricted to long-stay patients.
Why it matters
This study examined how Medicare hospice policy changes related to live discharge rates and length of stay, including among patients with Alzheimer's disease and related dementias. It is about hospice payment policy, not about treating, curing, or preventing Alzheimer's disease.
Study details
- Evidence strengthLow
How this study scored 35/100
Published in a peer-reviewed journal. Scored zero for study design, sample size, effect reported, studied in people and randomized / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Journal of pain and symptom management) |
| Journal's citation record | 2 / 4 | Journal of Pain and Symptom Management: journal h-index 213 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 3 / 5 | 2023 — within 6 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomized / blinded | 0 / 2 | No randomization or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 2 / 7 | Cited 9 times (OpenAlex, 2026-10-17) |
| Citations per year | 1 / 5 | 1.8 citations a year over 5 year(s) since 2023 |
| Impact for its field and year | 2 / 6 | Cited 1.6× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | 1 / 4 | Cited 6 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 1 / 4 | Last-listed author Ali Moghtaderi: h-index 17 (OpenAlex, whole career) |
| Institution's track record | 2 / 3 | University of Chicago: institution h-index 1,773 (OpenAlex) |
| Multicenter collaboration | 1 / 3 | OpenAlex lists 2 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 36526252) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 35 / 100 | — |
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