title: Effect of the Medicare face-to-face visit requirement on hospice utilization.
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.
  
  
  OBJECTIVE
  This study proposed to determine whether the face-to-face visit requirement increased the rate at which patients were decertified from hospice.
  
  
  METHODS
  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.
authors: Hospice of Lancaster County, Lancaster, Pennsylvania, USA.
authors: Joan
authors: J
authors: Harrold
authors: Pam
authors: P
authors: Harris
authors: Dena
authors: D
authors: Green
authors: Teresa
authors: T
authors: Craig
authors: David J
authors: DJ
authors: Casarett
mesh_terms: D000368:Aged; D004608:Eligibility Determination; D005260:Female; D017051:Hospice Care / Q000191:economics* / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D006278:Medicare / Q000191:economics*; D009723:Nurse-Patient Relations; D010817:Physician-Patient Relations; D012189:Retrospective Studies; D014481:United States