The benefit structure of Medicare and Medicaid may encourage post-hospitalization Medicare beneficiaries to go into skilled-nursing facilities instead of hospice, even though hospice may be more appropriate, according to a study published online by the Archives of Internal Medicine
The study of more than 5,100 Medicare patients found that of patients who lived in the community and had used Medicare's SNF benefit, 42% died in a nursing home, while of those patients who lived in the community and hadn't used the SNF benefit, only about 5% died in a nursing home.
The study authors suggested that because the Medicare hospice benefit does not cover room and board, patients are entering SNFs instead of hospice care. “Unfortunately, financial issues may contribute to why patients near the end of life are using the SNF benefit and not the hospice benefit,” the authors wrote.
As a result, SNFs should provide palliative care services for such patients, the authors concluded. “Perhaps having Medicare pay concurrently for post-acute SNF care and hospice services for the same condition could allow earlier incorporation of palliative care for these medically complex patients,” the authors wrote.