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J Palliat Med. 2018 Jan;21(1):55-61. doi: 10.1089/jpm.2017.0101. Epub 2017 Aug 17.

Association between Hospice Spending on Patient Care and Rates of Hospitalization and Medicare Expenditures of Hospice Enrollees.

Author information

1
1 Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai , New York, New York.
2
2 Geriatrics Research, Education and Clinical Center, James J. Peters Veterans Affairs Medical Center , Bronx, New York.
3
3 Leonard Davis Institute of Health Economics and Division of Internal Medicine, Perelman School of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania.
4
4 Hartford Institute for Geriatric Nursing, New York University College of Nursing , New York, New York.
5
5 Department of Health Policy and Management, Yale School of Public Health , New Haven, Connecticut.
6
6 Yale Global Health Leadership Institute , New Haven, Connecticut.

Abstract

BACKGROUND:

Care at the end of life is increasingly fragmented and is characterized by multiple hospitalizations, even among patients enrolled with hospice.

OBJECTIVE:

To determine whether hospice spending on direct patient care (including the cost of home visits, drugs, equipment, and counseling) is associated with hospital utilization and Medicare expenditures of hospice enrollees.

DESIGN:

Longitudinal, observational cohort study (2008-2010).

SETTING/SUBJECTS:

Medicare beneficiaries (N = 101,261) enrolled in a national random sample of freestanding hospices (N = 355).

MEASUREMENTS:

We used Medicare Hospice Cost reports to estimate hospice spending on direct patient care and Medicare claim data to estimate rates of hospitalization and Medicare expenditures.

RESULTS:

Hospice mean direct patient care costs were $86 per patient day, the largest component being patient visits by hospice staff (e.g., nurse, physician, and counselor visits). After case-mix adjustment, hospices spending the most on direct patient care had patients with 5.2% fewer hospital admissions, 6.3% fewer emergency department visits, 1.6% fewer intensive care unit stays, and $1,700 less in nonhospice Medicare expenditures per patient compared with hospices spending the least on direct patient care (p < 0.01 for each comparison). Ninety percent of hospices with the lowest spending on direct patient care and highest rates of hospital use were for-profit hospices.

CONCLUSIONS:

Patients cared for by hospices with lower direct patient care costs had higher hospitalization rates and were overrepresented by for-profit hospices. Greater investment by hospices in direct patient care may help Centers for Medicare and Medicaid Services avoid high-cost hospital care for patients at the end of life.

KEYWORDS:

Medicare expenditures; costs; end-of-life transitions; for-profit hospice; hospice

PMID:
28817376
PMCID:
PMC5757086
[Available on 2019-01-01]
DOI:
10.1089/jpm.2017.0101

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