Arizona-based Infinity Hospice Care achieved a 97% increase in patient visits during the last seven days of life using a predictive artificial intelligence system developed by the health care technology company WellSky.
Stepping up the frequency of these visits improves not only the quality of care but the hospice provider’s bottom line through Medicare’s service intensity add-on (SIA).
Medicare pays hospice organizations a per diem rate for providing routine home care. SIA allows hospices to receive payment for registered nurse and social worker visits during the last week of life in addition to the per diem payment. A Dec. 2017 study in the Journal of Palliative Care Medicine found that SIA payments represent a 21.6 percent increase over the standard per diem rate.
“This current system calls for a dramatic change in the way our industry serves our patients,” said Wes Little, vice president, WellSky Applied Insights, in a LinkedIn post announcing Infinity Hospice Care’s results. “Our team at WellSky believes that data-driven solutions utilizing AI & machine learning will play a key role in helping providers successfully make this change.”
Infinity Hospice Care, which provides end-of-life care for an average of 2,100 patients annually, used WellSky’s Applied Insights system to identify patients who were most likely to expire within seven days and to recognize gaps in care for those patients. The program uses an algorithm that runs in real-time on the organization’s entire patient population, identifying high-risk patients based on clinical indicators of imminent death.
The frequency of home visits by skilled nurses during the last seven days of life is a recurring quality issue among hospices in the United States.
“Predicting time of death is extremely challenging for hospices using traditional methods,” said Darren Bertram. “All hospices want to be present for their patients
at the end…however, families often do not recognize the need until it is too late.”
According to the U.S. Centers for Medicare & Medicaid Services (CMS), Medicare-enrolled patients do not receive a skilled nursing or social worker visit during their last seven days nearly 47 percent of the time. CMS also noted that close to 26 percent of Medicare patients do not receive a skilled visit on the day of death.
A case study released by WellSky described how Applied Insights alerted Infinity Hospice that a patient had an “elevated” risk of imminent death. The hospice responded by increasing registered nurse visits to twice a week and certified nursing assistant visits to seven days per week. Two weeks later, the patient shifted from “elevated” to “high” mortality risk, and the organization increased to three RN visits per week, thus ensuring the patient received necessary care and making the hospice eligible to receive SIA payments for those visits.
