Table 2. Differences in the Trajectories of the Percentage of New Monthly Enrollees With ADRD, Monthly Patient Census With ADRD, and Care Days Provided to Patients With ADRD Coinciding With Recent Policy Changes Affecting the Medicare Hospice Benefit.
| Characteristic | Minimally adjusteda | Fully adjustedb | ||
|---|---|---|---|---|
| Estimate (95% CI) | P value | Estimate (95% CI) | P value | |
| Percentage of new monthly enrollees with ADRD | ||||
| Pre-FTT/debility exclusion slopec | 0.05 (0.04 to 0.05) | <.001 | 0.05 (0.04 to 0.06) | <.001 |
| Change during FTT/debility exclusion notice | 3.74 (3.36 to 4.11) | <.001 | 3.81 (3.43 to 4.18) | <.001 |
| Post-FTT/debility exclusion slopec | 0.08 (0.05 to 0.12) | <.001 | 0.09 (0.05 to 0.12) | <.001 |
| Change during IMPACT Act passage | −1.49 (−2.22 to −0.76) | <.001 | −1.42 (−2.13 to −0.71) | <.001 |
| Change during IMPACT Act implementation | −1.87 (−2.61 to −1.13) | <.001 | −1.98 (−2.70 to −1.26) | <.001 |
| Post–IMPACT Act slopec | 0.11 (0.07 to 0.15) | <.001 | 0.11 (0.07 to 0.15) | <.001 |
| Change during TTP implementation | 0.22 (−0.15 to 0.58) | .24 | 0.15 (−0.21 to 0.51) | .42 |
| Post TTP-slopec | 0.02 (0.01 to 0.02) | <.001 | 0.01 (0 to 0.02) | .002 |
| Percentage of monthly patient census with ADRD | ||||
| Pre-FTT/debility exclusion slopec | 0.12 (0.11 to 0.12) | <.001 | 0.12 (0.11 to 0.12) | <.001 |
| Change during FTT/debility exclusion notice | 3.05 (2.82 to 3.28) | <.001 | 3.03 (2.81 to 3.26) | <.001 |
| Post-FTT/debility exclusion slopec | 0.12 (0.09 to 0.14) | <.001 | 0.12 (0.10 to 0.15) | <.001 |
| Change during IMPACT Act passage | −0.72 (−1.15 to −0.28) | .001 | −0.69 (−1.12 to −0.26) | .002 |
| Change during IMPACT Act implementation | −1.49 (−1.93 to −1.04) | <.001 | −1.47 (−1.91 to −1.03) | <.001 |
| Post–IMPACT Act slopec | 0.06 (0.03 to 0.08) | <.001 | 0.05 (0.03 to 0.07) | <.001 |
| Change during TTP implementation | −0.34 (−0.56 to−0.12) | .002 | −0.36 (−0.57 to −0.15) | <.001 |
| Post TTP-slopec | 0.03 (0.03 to 0.04) | <.001 | 0.03 (0.02 to 0.03) | <.001 |
| Percentage of monthly care days provided to patients with ADRD | ||||
| Pre-FTT/debility exclusion slopec | 0.13 (0.13 to 0.13) | <.001 | 0.13 (0.13 to 0.14) | <.001 |
| Change during FTT/debility exclusion notice | 3.15 (2.90 to 3.40) | <.001 | 3.12 (2.88 to 3.37) | <.001 |
| Post-FTT/debility exclusion slopec | 0.12 (0.09 to 0.14) | <.001 | 0.13 (0.10 to 0.15) | <.001 |
| Change during IMPACT Act passage | −0.53 (−1.01 to −0.05) | .03 | −0.51 (−0.99 to −0.04) | .03 |
| Change during IMPACT Act implementation | −1.45 (−1.94 to −0.96) | <.001 | −1.40 (−1.89 to −0.92) | <.001 |
| Post–IMPACT Act slopec | 0.05 (0.02 to 0.07) | <.001 | 0.04 (0.02 to 0.06) | .001 |
| Change during TTP implementation | −0.38 (−0.62 to −0.14) | .002 | −0.40 (−0.64 to −0.17) | <.001 |
| Post TTP-slopec | 0.03 (0.03 to 0.04) | <.001 | 0.03 (0.02 to 0.03) | <.001 |
Abbreviations: ADRD, Alzheimer disease and related dementias; FTT, failure-to-thrive; IMPACT, Improving Medicare Post-Acute Care Transformation Act; TTP, 2-tier payment.
Adjusted for month indicators and (absorbed) hospice fixed effects.
Minimally adjusted model and hospice-level covariates (ownership [for profit vs nonprofit, free-standing vs affiliated], total registered nurses, total employees, monthly demographic distributions [age, sex, race and ethnicity] of new enrollees, monthly percentage of total care days provided at the routine home care level and continuous home care level, and monthly percentage of care days provided in the community/home setting, nonskilled long-term care setting, and skilled nursing home/inpatient setting) and county-level covariates (county population, percentage population older than 65 years and age 85 years, county sex and race and ethnicity distributions, number of active physicians, rural-urban setting, percentage living below poverty level, median household income).
Slope coefficients are direct estimates of the slope during each specified period.