A recent JAMA Internal Medicine study reports that many hospice patients are not visited by a health care professional or social worker in the last 2 days of life. Patients at risk for not receiving a visit included those residing in nursing homes, those dying on a Sunday, or who were of black race. Regional variation was also noted with rural hospices such as those in Alaska having fewer visits.
The study, funded by the U.S. Centers for Medicare and Medicaid Services has led to changes in hospice care payment policy for 2016 so that hospices will be paid a higher rate for care provided during the final days of life. As of January 1, 2016, this new payment structure adds a “service intensity add-on payment” in the last seven days of life for up to four hours a day for visits by a registered nurse or medical social worker.