Journal of palliative medicine
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Comparative Study
Proportion and Patterns of Hospice Discharges in Medicare Advantage Compared to Medicare Fee-for-Service.
When Medicare Advantage (MA) patients elect hospice, all covered services are reimbursed under the Medicare fee-for-service (FFS) program. This financial arrangement may incentivize MA plans to refer persons to hospice near end of life when costs of care typically rise. ⋯ MA hospice patients' discharge patterns raised less concerns than FFS.
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To document the presence of hospice and palliative physicians in Medicare Shared Savings Program (MSSP) ACOs. ⋯ By rewarding innovation that lowers expenditures, the ACO model encourages attention to care that exhibits high variation and expense. Both hospice and palliative care have been shown to reduce costs and improve the patient experience, making them potentially powerful tools in an ACO's arsenal. However, the MSSP ACO model has not emphasized care of seriously and terminally ill individuals, and thus it is not surprising that there has been consistently low inclusion of hospice and palliative care physicians in MSSP provider networks.
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It is unknown how many hospice enrollees elect to be full code and if this is associated with higher hospice live discharge rates. ⋯ Those electing full code status on admission to hospice are at high risk of live hospice discharge after short enrollments, particularly nonwhite enrollees.
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To ensure seriously ill people and their families receive high-quality primary and specialty palliative care services, rigorous methods are needed to prospectively identify this population. ⋯ Standard administrative data are inadequate to identify this population. Defining the seriously ill denominator with high specificity, as described here, will focus efforts toward the highest-need segment of the population, who may indeed benefit most.
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Comparative Study
Comparison of Methods To Identify Advance Care Planning in Patients with Severe Chronic Obstructive Pulmonary Disease Exacerbation.
Advance care planning (ACP) is recommended for patients with chronic obstructive pulmonary disease (COPD). Yet, ACP documentation is often inaccessible at the time of impending respiratory failure, which may lead to unwanted and costly medical intensive care unit admissions. Electronic medical records (EMRs) contain directive fields and the ability to search for keywords and phrases, but these strategies to rapidly identify ACP have not been validated. ⋯ EMR directive fields may substantially underestimate ACP when used alone. As full clinician chart reviews are impractical in the emergent setting, text string searches may be a useful strategy to rapidly identify ACP discussions for clinical care and research.