The Medicare Hospice Payment System

A Consideration of Potential Refinements

Published In: Health Care Financing Review, v. 30, no. 4, Summer 2009, p. 47-59

Posted on RAND.org on January 01, 2009

by Nancy Nicosia, Elaine Reardon, Karl Lorenz, Joanne Lynn, Melinda Beeuwkes Buntin

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This article was published outside of RAND. The full text of the article can be found at the link above.

The purpose of this article is to examine variation in resource utilization across and within patient stays in the context of Medicare's per diem payment system for hospice. Visit-level resource utilization data were linked to patient-level diagnosis and demographics covering more than 68,000 Medicare patients admitted in 2002 and 2003. Our findings suggest that case mix adjustment based on diagnosis and demographics does not improve our ability to explain variation in resource utilization across stays. However, we do find that there is substantial variation in resource utilization within stays that may not be captured in the current per diem payment system

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