OIG Releases Report on Use of General Inpatient Hospice Care
Tuesday, May 14, 2013
by: VNAA Policy Team

Section: Public Policy and Advocacy

On May 6, the Office of Inspector General (OIG) released a report on Medicare hospice and the use of general inpatient (GIP) care in 2011 based on Medicare claims data. The report notes that GIP care is for pain control or symptom management provided in an inpatient facility that cannot be managed in other settings. It is intended to be short term and expensive. In 2011, the daily rate for GIP was $652 compared to $146 for routine home care.

The Centers for Medicare and Medicaid Services (CMS) has expressed concerns about possible misuse of GIP, such as care being billed for but not provided, long lengths of stay and beneficiaries receiving care unnecessarily. 
OIG found that Medicare paid $1.1 billion for GIP in 2011 with only 23 percent of Medicare hospice beneficiaries receiving GIP during the year. Of those that did receive GIP care, one third had stays of 5 days with 11 percent lasting 10 days or more. Most of the GIP care was proved in hospice inpatient units, as opposed to hospitals or skilled nursing facilities (SNFs).

The report found that hospices providing inpatient care in their own units recorded 50 percent longer patient stays and three times the proportion of Medicare revenue for those services than those that sent inpatients to other companies’ hospitals or SNFs. The report found that 953 hospices, or 27 percent of Medicare hospices, did not provide any GIP and 429 of these hospices only provided routine home level of hospice care.

OIG believes GIP warrants further review to ensure hospices are providing the appropriate level of care as oppose to overuse or stinting. The report also suggests that CMS should also focus on GIP issue as it considers options for hospice payment reform and quality measure development. To read the full OIG report, please click here.
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