Study results in Medicare payment policy change.
New research by the US Centers for Medicare and Medicaid Services has revealed that one of every eight dying patients in a home setting or a nursing home did not receive a visit from a medical professional during the last two days of their life, according to an article on mainenewsonline.com.
This finding has led to a change in policy by the agency as of January 1, that adds a “service intensity add-on payment” in the last seven days of life for a visit by a registered nurse or medical social worker for as many as four hours a day.
Dr. Joan Teno, a professor of medicine at the University of Washington in Seattle, and leader of the study, says the focus was on the last two days of life, because that is the time when symptoms increase and pain worsens. The researchers evaluated data from Medicare for over 600,000 patients who were receiving basic hospice care, and found just over 12 percent of those patients were not seen by medical professionals in the last two days of their lives. An assessment by the research team of over 3,400 hospices found that eight percent provided no visits to their patients in the final two days as well.
The study had some limitations, however, in that no factoring was made of families that made a decision to not receive hospice care, and the possibility that a previous decision that the patient would not have benefited from a visit in the final two days had been made.
According to the article, most patients get their hospice care at home, and some organizations provide massage and music therapy to patients as well. Almost all provide some type of bereavement services and short-term care to give family members a break during the trying final days of a relative’s life. The article continues to say that hospice will go wherever the patient is, home or healthcare facility, and some organizations even have their own facilities.
Still the study raises concerns about the quality of health care for older and frail people, particularly those in nursing homes with few family members to care for them. The researchers say more studies need to be done to make sure those people are being given good quality care as well.