Porthole
WITHDRAWN - Using Difference-in-Difference Cross Temporal Matching Approach to Evaluate Evolving Hospice Payment Policy in Aging Population (306617)
*Joan M Teno , OHSUKeywords: Aging, End of life Care, Medicare hospice Benefit
The payment model for hospice developed in 1982 focused on a cancer dying trajectory with the initial evaluation finding that cost saving when the hospice length of stay was not too short or too long. Now 3 decades later, hospice has expanded from cancer to multiple chronic, non-cancer illnesses with the aging of the population. An important methodological challenge in using administrative data to evaluate the potential cost saving is missing data on patient preferences with concern that controls preferred aggressive care and the lack of choosing the right controls resulted in observed finding of potential cost savings. In this talk, I will outline a new method, Difference-in-Difference Cross Temporal Matching Approach to evaluate changes in Medicare Payment Policy. With the expansion of hospice to nursing home in 1986, a natural experiment occurred with resultant rapid growth of hospice in the nursing home setting. We used administrative data (claims and the mandatory comprehensive MDS assessment) to study the impact of this rapid growth by comparing a subset of hospice users from 2009 with matched set of non-hospice users from 2003, who were considered likely to have use hosp