Hospice Medicare Margins: Analysis of Patient and Hospice Characteristics, Utilization, and Cost: Report prepared by the actuarial and consulting firm Milliman, on behalf of the National Partnership for Hospice Innovation (NPHI) highlights several cost and quality differences between for-profit and nonprofit hospices serving Medicare beneficiaries. It found Compared to for-profit hospices, nonprofits
- Report higher costs per day for direct patient care
- Have fewer patients who discontinue hospice care
- Generate lower Part A costs for Medicare in the subsequent 90 days among those patients who do decide to discontinue hospice care.
Palliative Care’s place in the care continuum: This infographic from Georgetown University’s School of Nursing illustrates how providers can explain the differences between curative, palliative, and end-of-life care to patients and their families. According to Jean Farley, D.N.P., R.N., P.N.P.-B.C., assistant professor at Georgetown University School of Nursing and Health Studies, the graphic encourages people to think of palliative care as an umbrella term that includes pain management, hospice, and end-of-life care.
Serious illness late in live: the public’s experiences: The Kaiser Family Foundation (KFF) conducted large scale nationally representative telephone survey to better understand people’s expectations about later life and efforts they’ve taken to plan for if they become seriously ill. Key takeaways:
- Many people report that they have not yet taken steps to plan for if they become seriously ill, although they are aware and understand that illness may affect them as they get older.
- Older black adults are much less likely than others to report having written documents outlining wishes or designating a health care proxy. People who are Hispanic are more apt to report financial challenges and uncertainty about late life and serious illness than black and white adults.
- Some seriously ill older adults say they are not getting enough needed help. Much of the public rates the U.S. health care system poorly in terms of the care it provides to older people with serious health needs, but most of those who are experiencing serious illness have more positive impressions.
Hospice Compare Fact Sheet (October 2017) – from CMS; provides patients, families and caregivers a a snapshot of the quality of care each hospice provides. Comparison metrics include the percentage of patients that are checked and treated for pain, or who are asked about their preferences for life-sustaining treatment and the overall quality of care provided by each facility.
Health Literacy and Palliative Care workshop summary
The National Academies of Sciences, Engineering and Medicine (formerly the Institute of Medicine) Roundtable on Health Literacy convened a one-day public workshop to explore the relationship between palliative care and health literacy and the importance of health literate communication in providing high-quality delivery of palliative care. This report summarizes the discussions that occurred throughout the workshop and highlights the key lessons presented, practical strategies, and the needs and opportunities for improving health literacy in the United States.
This hospice consumer guide from The Washington Post offers information on costs, services, profits, and various other comparison tools. CMS won’t have “hospice compare” data ready for several more years, so The Washington Post stepped in and created their own Consumer Guide to Hospice. The database is searchable by state, county and hospice name. It provides consumers with basic information such as accreditation, per-patient spending on care, years of operation, crisis care, and live discharges.
A study, “A Controlled Trial to Improve Care for Seriously III Hospitalized Patients” found many people nearing the end of life are not informed of their treatment options and their doctors are unaware of their preferences for treatment, which contributes to a lower quality of life at the end of life.
According to the Medicare Payment Advisory Commission, in 2009:
- 1.1 million people received hospice services
- Medicare spent $12 billion on hospice services
- 3,500 hospice providers received Medicare reimbursement, a 50 percent increase from 2000; most of the growth has been among for-profit hospice providers
Palliative care
Palliative care is a relatively new addition to the continuum of medical care. Palliative medicine was recognized as a new specialty in 2006 by the American Board of Medical Specialties. The American Academy of Hospice and Palliative Medicine maintains a national directory of physicians who are board certified in palliative medicine.
Hospital-based palliative care
Hospice and Palliative Care Nurses Association
The Center to Advance Palliative Care at the Mount Sinai School of Medicine has a training program to help doctors and nurses establish palliative care programs in their hospitals. Harvard Medical School reports a workforce shortage of 5,000-11,000 palliative care physicians.
Research
A 2010 study published in the New England Journal of Medicine found that people with metastatic lung cancer who received palliative care early in their diagnosis and had less aggressive end-of-life care lived 2.7 months longer than those who received standard treatment.
New developments/trends for reporters to watch
The Office of the Inspector General in the U.S. Department of Health and Human Services and the U.S. Department of Justice crack down on hospices that aren’t following Medicare rules.
Bloomberg News published an investigation of hospices that enrolled people who were not terminally ill, a violation of Medicare eligibility requirements.
Kaiser Health News reported on a whistleblower complaint that was joined by the federal government against a for-profit hospice that allegedly submitted false Medicare claims for non-terminally ill people. The whistleblowers allege their employer offered incentives to employees (massage chairs, trips to exotic locations, etc.) to encourage them to meet aggressive enrollment targets. See the U.S. Department of Justice press release.
These reports are in addition to earlier actions by the Justice Department against hospices for abusing the benefit.
Here are more resources to explore:
Medicare website with information on the hospice benefit and a report from the Medicare Payment Advisory Commission
Get a list of hospitals with palliative care programs by state or the number and distribution of hospitals with palliative care according to congressional district.
American Academy of Hospice and Palliative Medicine
National Palliative Care Research Center
International Association for Hospice & Palliative Care
Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT)
More tips and sources are included in the tip sheet “Reporters’ guide to hospice and palliative care.”