Medicare Advantage special needs plan (SNP) beneficiaries were more likely to use lower-quality hospices than those enrolled in fee-for-service Medicare.

Researchers from the Perelman School of Medicine at University of Pennsylvania in Philadelphia examined Medicare enrollment and claims data for 4.2 million decedents and 2.2 million hospice enrollees from Jan 1, 2018 to Dec. 31, 2019. Among other findings, results indicated that MA SNP beneficiaries were more likely to receive care from hospices with lower Hospice Quality Reporting Program (HQRP) scores.

“These results suggest that policymakers should consider incentivizing referrals to high-quality hospices and approaches to educating beneficiaries on identifying high-quality hospice care,” researchers wrote in the study, published in JAMA Network Open.

Fee-for-service beneficiaries and those enrolled in regular Medicare Advantage sought care at hospices of similar quality, the study found. Referral networks also played a key role in patients’ hospice choice when it comes to quality, according to the research.

The study examined data pertaining to all Medicare hospice decedents in 2018 or 2019, excluding those who received care in 2017.

Overall, general MA beneficiaries were slightly more likely to elect hospice than those in fee for service. Those in SNPs and dual-eligible patients generally went with hospices with lower performance on quality metrics.

“Given their lack of hospice benefits, MA plans have different financial incentives around the timing of hospice care initiation and the hospice agency to which enrollees are referred than they do with other covered services,” researchers indicated in the study. “For example, MA plans have a financial incentive to refer beneficiaries to hospice if they are nearing the end of life and are using high intensity services, as it removes costly beneficiaries from the plan rolls.”