Medicare Service-Intensity Payments Not Improving Quality of Care

Evidence suggests that Medicare’s service intensity add-on (SIA) payment structure for hospices is boosting payments but thus far has failed to improve the quality of care.

The US Centers for Medicare & Medicaid Services (CMS) introduced SIA in 2016 to give hospices a greater financial incentive for improving care during the last seven days of the patient’s life. Medicare hospice claims data for 2016 and 2017 show that increased payments have not led to significant improvement, with total skilled hours during the patient’s last week rising only 2.2% between 2016 and 2017.

“As these end-of-life care metrics will likely be a core element of the future Hospice Star Ratings, it is critical for agencies to know where they stand against their peers nationally,” said Wes Little, vice president of WellSky, Inc. in a LinkedIn post. “Agencies should begin working now to build and execute on strategies for increasing performance over time.”


Skilled nursing visits during the last week of life is one of the seven quality measures that CMS uses to evaluate providers for is Hospice Compare website, which allows consumers to benchmark performance of individual providers against one another.

CMS is currently working to incorporate a 5-star rating system for hospice providers into the website.

“Any additional care at end of life will be rewarded in higher patient and family satisfaction, greater SIA reimbursement, and eventually agency growth through more referrals,” Little said.