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Prescription Waste Among Hospice Patients.

Record Type:	Language materials, manuscript : Monograph/item
Title/Author:	Prescription Waste Among Hospice Patients./
Author:	Irvin, Katherine Jean.
Description:	1 online resource (192 pages)
Notes:	Source: Dissertations Abstracts International, Volume: 86-02, Section: B.
Contained By:	Dissertations Abstracts International86-02B.
Subject:	Information technology. -
Online resource:	click for full text (PQDT)
ISBN:	9798383622773

Prescription Waste Among Hospice Patients.
Irvin, Katherine Jean.

Prescription Waste Among Hospice Patients. - 1 online resource (192 pages)

Source: Dissertations Abstracts International, Volume: 86-02, Section: B.

Thesis (Ph.D.)--George Mason University, 2024.

Includes bibliographical references

The purpose of this dissertation is to assess Part D prescription waste in hospice patients, in three related studies. This dissertation seeks to characterize Part D prescription waste among linked Surveillance, Epidemiology, and End Results (SEER) Medicare and a random 5% sample of Medicare fee-for-service hospice patients by examining policy intervention impacts, assess the quantity and type of prescription medication at time of death, use a novel methodologies such as random forests to identify factors that influence the likelihood of such prescriptions on hand at time of death, and assess life expectancy as a factor in determining prescription lengths that reduce prescriptions on hand at death.Overview of Hospice and Part D ProgramsHospice was created with the goal of providing medical care that focuses on optimizing quality of life and mitigating suffering among people with terminal illness. For eligible Medicare patients, hospice is covered under the Medicare Part A insurance benefits and includes care for an individual's terminal illness and related conditions. Hospice uses teams to provide doctor services, nursing care, medical supplies, prescription drugs, therapy (physical, occupational, and speech-language), social worker support, dietary counseling, grief counseling, and short-term inpatient or respite care.Medicare Part D is a voluntary prescription drug benefit provided by private insurance sponsors for a monthly premium. The program aims to make prescription medications more affordable and accessible to Medicare recipients. The benefit covers patient's prescription drugs in most cases, but there are circumstances where drugs are covered instead under either Medicare Part A or Part B. One exception is when a patient elects hospice, and the prescription drugs related to the care of the terminal illness and conditions are covered under the Medicare Part A benefit. Medications unrelated to the patient's terminal illness may still be obtained through the Part D benefits.In the past decade, hospice care has prioritized quality while aiming to reduce unnecessary waste. The Center for Medicare and Medicaid Services (CMS) defines waste as practices leading to unnecessary costs for the Medicare program. Since October 2010, CMS has issued several communications to Part D Sponsors and Hospice Providers highlighting the problem of Medicare paying for drugs under Part D that should be covered by hospice Medicare Part A. This inappropriate billing has led to significant costs and waste for the Medicare program. The following reviews the laws, practices, and/or guidelines CMS has published from 2008 to present providing historical context for understanding Part D prescription waste among hospice patients.Years 2008-2013In June 2008, the CMS through the Federal Registrar released the first major revision of Medicare Hospice Conditions of Participation (CoPs) since the Medicare Hospice Benefit was established in 1983. The major revision related to hospice patient's prescriptions (including Part D medications) included:CFR-Explanation of Revision§ 418.106(e)Added clarification that reiterates the requirement that hospices must provide all drugs and supplies related to a patient's terminal illness and related conditions and not expect patients to obtain drugs related to the terminal illness and related conditions through Medicare Part D. And that longstanding, preexisting conditions and comorbidities are included in the hospice bundle of services as written in the original implementing regulations of the Medicare hospice benefit. However, if a patient necessitates drugs unrelated to the terminal illness, they may seek coverage through Medicare Part D. CFR-Explanation of Revision§ 418.54(c)Clarified the term "unnecessary drugs" as part of the content of the comprehensive assessment and reiterated that all medications should be included in the review in order to develop a plan of care. The ruling went on to clarify that as part of the drug profile review, the assessment should include a patient's prescription and over-the-counter drugs in use, drug effectiveness, side effects, drug interactions, duplicate therapies, and under or overdosing.Following these changes and clarifications it wasn't until October 2010 that CMS released a Memorandum entitled Preventing Part D Payment for Hospice Drugs. The memorandum indicated there were concerns that Part D sponsors were paying for drugs that should be the responsibility of the Medicare hospice provider. Guidelines were released directing Part D sponsors to communicate with their network pharmacies to ensure Medicare hospice drugs were not billed to Part D. CMS indicated they would provide best practices for doing so by late 2011.However, following an initial proposal (in February 2011), by April 2011 CMS issued as part of the Announcement of CY 2012 Medicare Advantage Capitation Rates and Medicare Advantage and Part D Payment Policies a section detailing the best practices for "Preventing Part D Payment for Hospice Drugs". The practices recommended Part D sponsors utilize patient-level transaction reply reports (TRR) they had previously. (Abstract shortened by ProQuest).

Electronic reproduction.
Ann Arbor, Mich. :
ProQuest,
2024

Mode of access: World Wide Web

ISBN: 9798383622773Subjects--Topical Terms:

559429
Information technology.
Subjects--Index Terms:

HospicesIndex Terms--Genre/Form:

554714
Electronic books.

Prescription Waste Among Hospice Patients.
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For eligible Medicare patients, hospice is covered under the Medicare Part A insurance benefits and includes care for an individual's terminal illness and related conditions. Hospice uses teams to provide doctor services, nursing care, medical supplies, prescription drugs, therapy (physical, occupational, and speech-language), social worker support, dietary counseling, grief counseling, and short-term inpatient or respite care.Medicare Part D is a voluntary prescription drug benefit provided by private insurance sponsors for a monthly premium. The program aims to make prescription medications more affordable and accessible to Medicare recipients. The benefit covers patient's prescription drugs in most cases, but there are circumstances where drugs are covered instead under either Medicare Part A or Part B. One exception is when a patient elects hospice, and the prescription drugs related to the care of the terminal illness and conditions are covered under the Medicare Part A benefit. Medications unrelated to the patient's terminal illness may still be obtained through the Part D benefits.In the past decade, hospice care has prioritized quality while aiming to reduce unnecessary waste. The Center for Medicare and Medicaid Services (CMS) defines waste as practices leading to unnecessary costs for the Medicare program. Since October 2010, CMS has issued several communications to Part D Sponsors and Hospice Providers highlighting the problem of Medicare paying for drugs under Part D that should be covered by hospice Medicare Part A. This inappropriate billing has led to significant costs and waste for the Medicare program. The following reviews the laws, practices, and/or guidelines CMS has published from 2008 to present providing historical context for understanding Part D prescription waste among hospice patients.Years 2008-2013In June 2008, the CMS through the Federal Registrar released the first major revision of Medicare Hospice Conditions of Participation (CoPs) since the Medicare Hospice Benefit was established in 1983. The major revision related to hospice patient's prescriptions (including Part D medications) included:CFR-Explanation of Revision§ 418.106(e)Added clarification that reiterates the requirement that hospices must provide all drugs and supplies related to a patient's terminal illness and related conditions and not expect patients to obtain drugs related to the terminal illness and related conditions through Medicare Part D. And that longstanding, preexisting conditions and comorbidities are included in the hospice bundle of services as written in the original implementing regulations of the Medicare hospice benefit. However, if a patient necessitates drugs unrelated to the terminal illness, they may seek coverage through Medicare Part D. CFR-Explanation of Revision§ 418.54(c)Clarified the term "unnecessary drugs" as part of the content of the comprehensive assessment and reiterated that all medications should be included in the review in order to develop a plan of care. The ruling went on to clarify that as part of the drug profile review, the assessment should include a patient's prescription and over-the-counter drugs in use, drug effectiveness, side effects, drug interactions, duplicate therapies, and under or overdosing.Following these changes and clarifications it wasn't until October 2010 that CMS released a Memorandum entitled Preventing Part D Payment for Hospice Drugs. The memorandum indicated there were concerns that Part D sponsors were paying for drugs that should be the responsibility of the Medicare hospice provider. Guidelines were released directing Part D sponsors to communicate with their network pharmacies to ensure Medicare hospice drugs were not billed to Part D. CMS indicated they would provide best practices for doing so by late 2011.However, following an initial proposal (in February 2011), by April 2011 CMS issued as part of the Announcement of CY 2012 Medicare Advantage Capitation Rates and Medicare Advantage and Part D Payment Policies a section detailing the best practices for "Preventing Part D Payment for Hospice Drugs". The practices recommended Part D sponsors utilize patient-level transaction reply reports (TRR) they had previously. (Abstract shortened by ProQuest).
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