Also this week in the New England Journal of Medicine a special report shows a marked increase in the use of hospice care within nursing homes. In 2004, 27.6 percent of nursing home decedents used hospice compared to 39.8 percent in 2009—a 44 percent increase in that time period. Increased use of hospice was associated with decreases in the rates of hospital transfers, ICU use within the nursing home, and decreased use of feeding tubes. According to the researchers, between 2004 and 2009 the expansion of hospice was associated with a mean net increase in Medicare expenditures of $6,761, which stemmed from greater additional spending on hospice care ($10,191) rather than reduced spending on hospital and other care ($3,430). 

Separately, the Kaiser Family Foundation reported that in an analysis of Nursing Home Compare, Medicare’s rating system for nursing home providers, top ranked homes are hard to find in certain states. Texas scored lowest with 51 percent of its nursing homes ranked one or two stars out of five, followed by Louisiana (49 percent) and Oklahoma, Georgia and West Virginia tied for third (each had 46 percent). Other states with at least 40 percent one-two star rating include North Carolina, Tennessee, Kentucky, Ohio, Pennsylvania and New York. Variability in nursing home care is high; more than half of homes nationwide earn four or five stars.

Our Take: During the same time period, the increased use of hospice in nursing homes mirrors a three-fold increase in the number of for-profit hospice providers (not-for-profit hospices were effectively unchanged or declined). But the number of SNF-based hospices remained constant. That means nursing homes either adopted hospice care as a best practice, or saw hospice as a new source of revenue. Or both.

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