(143) Shifting Patterns of Hospice Medication Use and Medicare Payments in the United States Between 2014-2018

Publication Number: 817

Background: The appropriate use of medications to manage disease conditions and symptoms in hospice is critical for the delivery of high-quality care to patients approaching the end of life. In the US, Medicare policy changed in 2014 to encourage a shift of medication payments away from the outpatient Part D benefit to the Medicare hospice benefit, effectively constraining material resources available to hospice programs.

Objectives: To describe changing patterns of medication use and payments in US Medicare hospice programs after the 2014 Medicare hospice policy change.

Methods: Cross-sectional description of the total charges for all medications submitted for payment under the Medicare hospice benefit in 2014 and 2018. We also describe the prevalence of the top 100 medications submitted for payment. Data source are national revenue center claims submitted by hospices from 2014 to 2018 for all Medicare-certified hospices in the US.

Results: In 2014 there were 4,193,775 hospice enrollees whose mean age was 82.7 years (SD 10.6) and 63.3% were women. In 2014, of the top 100 medications submitted to Medicare, 46 were end-of-life (EOL) drugs (analgesics, antiemetics, laxatives, anxiolytics), 31 were chronic disease drugs, 13 were antibiotics, and 8 met STOPP Frail criteria for potentially inappropriate medications at end of life. Total charges for medications submitted in 2014 was $1,146,996,894. In 2018 there were 5,095,871 enrollees, which represents a growth of 21% in enrollment; their mean age was 83.0 years (SD 10.5) and 62.8% were women. In 2018, of the top 100 medications submitted to Medicare, 42 were EOL drugs, 34 were chronic disease drugs, 11 were antibiotics, and 8 met STOPP/Frail criteria for potentially inappropriate medications at EOL. Total charges for medications submitted in 2018 was $1,532,721,090, which represents a 33.6% increase in total charges for medications under the Medicare hospice benefit.

Conclusions: Between 2014 and 2018, there was a 33.6% increase in overall charges for medications submitted for coverage under the Medicare Hospice benefit. During that time, among the top 100 medications submitted, there was growth in the number of chronic disease drugs submitted but no change in the number of potentially inappropriate medications submitted. Whether this represents a corresponding decrease in Part D payments remains to be examined.