Are Reimbursement Changes Affecting Hospice Referrals In The Skilled Nursing Facility?: A Feasibility Study

Purpose: The purpose of this project was to determine barriers and facilitators to hospice referral in three nursing home settings and to increase the utilization of this service Background: Nearly 1.5 million individuals reside in nursing homes across the United States however only 14.5 percent of those individual are enrolled in hospice at their time of death. There is a large amount of evidence showing that individuals who die while on hospice services have increase in satisfaction and are more comfortable at their time of death. However, there is a dearth of information regarding barriers to referral in the nursing home setting. Method/Results: Three skilled nursing facilities in the Salt Lake Region were identified as appropriate sites for this project. A survey was provided to department heads and direct care staff during their monthly in-service that asked them about their knowledge of hospice, facilitators to hospice referrals and barriers to hospice referrals. A PowerPoint was created based on the needs identified from the survey. An education session was held with the department heads and direct care staff and the PowerPoint was presented. A post education survey was distributed and results showed that 100% of individuals surveyed had an increase in knowledge regarding hospice. The hospice referral rates were then compared for the two months prior to the education and two months post education. There was no significant difference in the hospice referrals pre to post intervention with a significant value of .157 (p<0.05). Conclusion: The biggest barrier to hospice referral identified was reimbursement. During the development phase of the project, we identified that facilities were leasing their beds to county hospitals to take advantage of the Medicaid Upper Payment Limit that increased their reimbursement significantly. However, this increase did not apply to patients enrolled in hospice services. A change to Medicaid reimbursement must be made to provide equal payment to the skilled nursing facility for those patients who use long term Medicaid and those whom use hospice Medicaid. Without this change, there is a disincentive for the facility to place patients on this service.