Abstract
BACKGROUND: Although many patients enter hospice close to death, some enroll for more than six months. In 2011 the U.S. Centers for Medicare and Medicaid Services (CMS) required that these long-stay patients receive a face-to-face visit by a physician or nurse practitioner to ensure that they continue to meet eligibility criteria. OBJECTIVES: This study proposed to determine whether the face-to-face visit requirement increased the rate at which patients were decertified from hospice. DESIGN: The study was a retrospective cohort study in six U.S. hospices. Decertification from hospice within 10 months of enrollment was measured. RESULTS: Of 23,638 patients, 11,788 (49.9%) would have been affected by the face-to-face requirement. In bivariate analysis, there was a significant decrease in the decertification rate after the requirement was implemented-371/11,788 (3.2%) versus 578/11,850 (4.9%); odds ration (OR): 0.63; 95% CI 0.55-0.72; p<0.001. In a multivariable logistic regression model adjusting for changes in patient characteristics and clustered by hospice, there was still a reduction in decertifications-3.4% versus 5.2%; OR 0.67; 95% CI 0.47-0.97; p=0.034. Although the impact of the face-to-face requirement varied among hospices, all hospices had a decrease in decertification rates (absolute adjusted reduction between 1.4% and 3.6%). CONCLUSIONS: The face-to-face requirement may decrease hospice discharges, contrary to its intention.