title: Including hospice in Medicare capitation payments: would it save money?
abstract: Hospice services received by Medicare risk-based health maintenance organization (HMO) enrollees are paid on a non-capitated basis, creating financial incentives for HMOs to encourage their terminally ill patients to elect hospice. Using Medicare administrative records for 1998, we found that hospice enrollment in the last month of life was significantly higher among HMO enrollees than among beneficiaries in fee-for-service (FFS). However, low mortality rates among HMO enrollees produced similar population-based rates of hospice use in the HMO and FFS sectors. Simulations showed that including hospice care under capitation payments in July 1998 would have produced very small savings for Medicare.
authors.affiliation: griley@cms.hhs.gov
authors.forename: G
authors.initials: G
authors.lastname: Riley
authors.forename: C
authors.initials: C
authors.lastname: Herboldsheimer
mesh_terms: D000328:Adult; D000368:Aged; D002204:Capitation Fee; D017046:Cost Savings; D018588:Fee-for-Service Plans; D005260:Female; D006279:Health Maintenance Organizations / Q000191:economics*; D017051:Hospice Care / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D016344:Medicare Part A / Q000191:economics / Q000458:organization & administration; D016345:Medicare Part B / Q000191:economics / Q000458:organization & administration*; D008875:Middle Aged; D009026:Mortality; D020414:Risk Sharing, Financial; D014481:United States / Q000453:epidemiology