A Secondary Analysis of the Intensity of Hospice Visits Among Medicare Decedents in the Last Seven Days of Life by Place of Residence

Background In 2016, Medicare finalized the Service Intensity Add-on (SIA) payment policy to increase the intensity of hospice registered nurse (RN) or social worker (SW) visits in the last 7 days of life. The research objective was to compare the intensity of hospice RN or SW visits in the last 7 days of life among older decedents who received a hospice visit, while residing in a traditional home, an assisted living facility, or long-term nursing home. Methods A retrospective analysis using 2016-2018 Medicare data of decedents 65 years or older (n= 2 067 863) related to the Medicare SIA payment policy. Intensity was defined as the number and duration of hospice RN or SW visits in the last 7 days of life using Medicare claims code G0299 and G0155. Results Regression results suggest that decedents who received a SIA related visit while residing in an assisted living facility, had on average a slightly longer duration of hospice RN visits in the last 7 days of life, compared to decedents residing in a traditional home, after controlling for demographics and other factors (P<.0001). The duration of hospice RN visits remained unchanged among decedents who received a SIA visit in 2017 or 2018, when compared to 2016 (P <.0001). Overall the average number of hospice SW visits did not differ by place of residence among decedents who received a SIA visit. Conclusions Among decedents who received a SIA related visit, the duration of hospice RN visits were slightly different by place of residence.

An Evaluation of the Service Intensity Add-On Payment Policy Reform in the Medicare Hospice Benefit

In 2016, the Centers for Medicare & Medicaid Services (CMS) implemented the Service Intensity Add-On (SIA) payment, which incentivized skilled nurse and medical social worker (SN/MSW) visits in the last seven days of life. Little is known about the impact of this initiative. Using 100% Medicare hospice claims, we identified a 10% random sample of Medicare hospice beneficiaries utilizing routine home care service during calendar years 2012-2018. We compared the provision of SN/MSW visits on service dates before and after the SIA’s implementation relative to beneficiaries’ date of death. We also determined hospice providers’ success in providing SN/MSW visits in the last days of life and categorized all providers into quintiles according to the average rate of these visits in the period prior to the SIA’s implementation. Cumulative over the last seven days of life, we calculated an increase of 15.7 SN/MSW minutes (95% confidence internal [CI] 14.9-16.5 minutes) per beneficiary after the SIA was implemented. The per-minute increase was greatest on days nearer to death (4.0 minutes day of death, 95% CI 3.6-4.2). There was no detectable visit increase on days which were ineligible for the SIA. Additionally, those providers in the quintile providing the lowest rate of SN/MSW visits pre-SIA exhibited a 14-percentage point increase in rates of these visits, the third, fourth, and fifth quintiles exhibited little change over time. Further monitoring is needed to ensure beneficiaries receive adequate end-of-life care.

Managerial Ownership and Firm Value of Selected Nigeria Listed Manufacturing Companies: Does Dividend Payment Policy Really Mediate?

Shareholders play a vital role in an organization through parting with their funds which determines the continuity and survival of the organization. As a result of this, regular payment of dividends as at when due to different shareholders is a concerned of every stakeholder in an organization. Therefore, this study examined the mediating effect of dividend payment policy on the relationship between managerial ownership and firm value of listed manufacturing companies in Nigeria. This study focused on ten manufacturing firms that are listed on Nigeria Stock Exchange (NSE) from 2010 to 2019 using panel pool technique and Hausman’s test. The findings from this study established that there was a partial mediation of managerial ownership, dividend payout and leverage ratio on firm value. In addition, managerial ownership (20.8%) had an inverse and significant effect on firm value; while, dividend payout ratio and leverage ratio had a direct and significant effect on it with each contributing 15.2% and 3.8% to it respectively. On mediation, the finding discovered that dividend payout through managerial ownership indirectly contributed 33.1% to managerial ownership. The study concluded that managerial ownership and dividend payment policy partly contributed to firm value with dividend payment policy playing an indirect role through increase in managerial ownership. Therefore, recommended that organizations should endeavor to review their dividend payment policy and ensure that dividend accrue to the firms’ coffer are pay as at when due. Also, managers of listed firms are strongly advised to take more of long-term loan on intending capital projects.

Influence Relaxation Policy Fees on COVID-19 Pandemic and Service Quality Claims against the Realization of Dues Payment Compliance BPJSK in Branch Office Driyorejo-Gresik East Jawa-Indonesia

In the conditions of the Covid-19 pandemic, it had a very large impact not only on the health aspect, but also on the labor and economic aspects. The industrial world has been affected so much that the industrial world has stopped its production activities so that there has been a reduction in the workforce in production by being dismissed and even disconnected from their work. This condition is what makes the government take action, especially in terms of employment in fulfilling the obligation to pay BPJSK output through a relaxation or softness policy in paying contributions. Another policy is the claim service for BPJSK participants if there is a risk that results in the realization of the claim.This research is to analyze with the policy of relaxation of payment of dues and claim services associated with their influence on participant compliance in paying BPJSK dues. The population / research sample was the participants of the BPJSK Gresik Driyorejo Branch, using a questionnaire to obtain data on the perception of relaxation policies, service quality and compliance with payment of dues.Based on the results of data analysis, it shows that: first, the premium payment policy has a significant effect on dues pay compliance, second, the service quality of claims has a significant effect on awareness of premium payments, and third, the policy of relaxation of contributions and the quality of service claims has a significant effect on the premium. payment of dues for BPJSK members at the Gresik Driyorejo Branch.