A Secondary Analysis of the Intensity of Hospice Visits Among Medicare Decedents in the Last Seven Days of Life by Place of Residence.

Background: In 2016, Medicare finalized the Service Intensity Add-on (SIA) payment policy to increase the intensity of hospice registered nurse (RN) or social worker (SW) visits in the last 7 days of life. The research objective was to compare the intensity of hospice RN or SW visits in the last 7 days of life among older decedents who received a hospice visit, while residing in a traditional home, an assisted living facility, or long-term nursing home.

Methods: A retrospective analysis using 2016-2018 Medicare data of decedents 65 years or older (n= 2 067 863) related to the Medicare SIA payment policy. Intensity was defined as the number and duration of hospice RN or SW visits in the last 7 days of life using Medicare claims code G0299 and G0155.

Results: Regression results suggest that decedents who received a SIA related visit while residing in an assisted living facility, had on average a slightly longer duration of hospice RN visits in the last 7 days of life, compared to decedents residing in a traditional home, after controlling for demographics and other factors (P<.0001). The duration of hospice RN visits remained unchanged among decedents who received a SIA visit in 2017 or 2018, when compared to 2016 (P <.0001). Overall the average number of hospice SW visits did not differ by place of residence among decedents who received a SIA visit.

Conclusions: Among decedents who received a SIA related visit, the duration of hospice RN visits were slightly different by place of residence.