# Evaluating impact of recent federal policy changes on hospice utilization among patients with Alzheimers Disease and Related Dementias

> **NIH NIH R03** · GEORGE WASHINGTON UNIVERSITY · 2020 · $47,850

## Abstract

PROJECT SUMMARY
Recent changes to the Medicare hospice benefit may adversely impact access to hospice care for terminal
Alzheimer’s disease and related dementia (ADRD) patients, who currently make up 16% of all hospice patients
and 36% of aged decedents. In 2014, the IMPACT Act introduced stringent hospice auditing procedures
targeting long patient stays, and in 2016, Medicare implemented a two-tiered payment schedule reducing
hospice reimbursement after 60 days. Both changes aimed to dis-incentivize hospices from selecting for long-
stay patients, who were more profitable (and admitted at higher rates to for-profit agencies) than short-stay
patients. ADRD patients typically have longer length of stay (LOS) due to their lengthier and less predictable
end-of life (EOL) trajectories, and while circumstantial and qualitative evidence suggests that these changes
may reduce ADRD patient hospice use, the effect of these policies is currently unknown. Hospice has been
recognized as the best way to maintain the high quality of life (QOL) for severely-ill patients, and appears
particularly beneficial to EOL ADRD patients given their complex needs. Therefore, decreased access to
hospice would adversely impact QOL for ADRD patients and their families. Thus, there is a critical need to
understand how these policies affect ADRD patients’ use of hospice. Our proposal directly addresses this
need. We will determine the extent to which the implementation of the IMPACT Act (Aim 1) and the two-tiered
payment schedule (Aim 2) affect (a) hospice admission, (b) hospice LOS, and (c) the rate of live discharges for
ADRD patients. Additionally, because for-profit hospice agencies may be more impacted by increased audits
and changes in monetary incentives, we propose to examine the extent to which policy effects on these
outcomes are different at for-profit versus non-profit agencies (Aim 3). To accomplish these aims, we will use
econometric methods to analyze Medicare hospice claims data from 2008 to 2018. This proposed research is
a timely and necessary first step to investigate the policy effects on ADRD patient access to and use of
hospice. The findings of this research will (i) advance our understanding of how hospice providers respond to
regulatory oversight and monetary incentives, and will (ii) inform how policy levers can be used to improve the
Medicare hospice benefit in design, implementation, and oversight, in order to maximize the value and quality
of EOL care for the ADRD patient population. Our findings will also have a translational impact because other
Medicare beneficiaries with ‘non-traditional’ hospice diagnoses, who also have long and unpredictable EOL
trajectories, may be similarly impacted. This proposal represents a first, necessary step in a planned research
agenda to improve EOL care for ADRD patients through use of policy and health systems changes.

## Key facts

- **NIH application ID:** 9873882
- **Project number:** 5R03AG061499-02
- **Recipient organization:** GEORGE WASHINGTON UNIVERSITY
- **Principal Investigator:** Melinda C Power
- **Activity code:** R03 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $47,850
- **Award type:** 5
- **Project period:** 2019-02-15 → 2022-01-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9873882

## Citation

> US National Institutes of Health, RePORTER application 9873882, Evaluating impact of recent federal policy changes on hospice utilization among patients with Alzheimers Disease and Related Dementias (5R03AG061499-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9873882. Licensed CC0.

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