For-Profit Hospices May Prefer Certain Types of Patients:
TUESDAY, Feb. 1 (HealthDay News) -- End-of-life care facilities
run for profit are more likely to have patients who require
less-skilled care on the part of the hospice, or patients who need
longer times in hospice care, research reveals.
Under the current Medicare reimbursement system -- which pays
hospices a flat daily rate, regardless of care needs -- such
patients would likely cost less to care for, according to the
"We found that for-profit hospices had more patients with non-cancer diagnoses, especially dementia, that were associated with fewer visits per day from hospice nurses and social workers," noted the study's lead author, Dr. Melissa Wachterman, a general medicine research fellow, and a palliative care physician at Harvard Medical School and Beth Israel Deaconess Medical Center in Boston.
"There was a difference in the distribution of diagnoses. Non-cancer diagnoses were more common in for-profit hospices. And, under the current reimbursement system, those patients may be more profitable," she explained.
More reassuring for families, however, is the finding that
patients' care needs were met in both for-profit and non-profit
hospice programs, Wachterman noted.
Results of the study appear in the Feb. 2 issue of the
Journal of the American Medical Association.
Hospice is a type of care provided to people who are dying. The
aim of hospice care isn't to prolong life, but to provide comfort
care in the last weeks or months of life. Pain control is an
important aspect of hospice care, as is counseling for the whole
Since 2000, the number of for-profit hospice agencies in the
United States has more than doubled. In 2000, there were 725
for-profit hospices, and in 2007 that number had risen to 1,660,
according to the study. During that same period, the number of
non-profit hospice programs held steady at about 1,200
About 84 percent of people enrolled in hospice programs are
receiving Medicare benefits, and about 40 percent of those who die
while on Medicare were using hospice.
For this study, Wachterman and her colleagues reviewed data from
the 2007 National Home and Hospice Care Survey that included more
than 4,700 people using hospice.
They found that non-profit hospices were much more likely to
have enrolled people with a cancer diagnosis. Non-profits had about
48 percent of patients with cancer compared to 34 percent in
for-profit hospices, according to the study.
On the other hand, for-profit hospices were much more likely to
have patients with dementia than were non-profits; 17.2 percent
versus 8.4 percent.
Compared with nonprofit hospice agencies, for-profit hospices
had a higher proportion of patients residing in nursing homes and a
lower proportion living at home. People at for-profit hospice
agencies were also likely to stay longer, an average of 20 days
compared to 16 for non-profit hospices.
Wachterman said that patients and their families are generally
given a choice of hospice care programs by their care coordinator
in the hospital, and that certain hospices may become more
well-known for providing a particular type of care. But, she said,
this study wasn't able to address the question of whether or not
certain hospices were actually seeking out specific types of
However, she said, the study's findings do point to a need to
make a change in the way hospices are reimbursed. "Under the
Medicare benefit, hospices are paid a flat daily rate to take care
of patients, regardless of the patient care needs. Policy makers
may need to consider the possibility of reimbursing at a different
daily rate for patients with different diagnoses and different care
intensity," suggested Wachterman.
Dr. Joan Teno, a member of the board of the National Hospice and
Palliative Care Organization, disagreed with the notion that
dementia patients might need less care than cancer patients,
particularly in the area of pain management.
"Both populations have really important unmet care needs," said Teno, who's also a professor of community health and medicine at the Center for Gerontology at the Warren Alpert School of Medicine at Brown University, in Providence, R.I.
Teno also said there's an important factor missing from this
study, and that's a measure of the quality of care received at each
type of hospice.
"I'm not sure that a hospice's tax status would help me choose. We need evidence that can help families select a high quality hospice program," she said.
To learn more about choosing hospice, visit the
Hospice Foundation of America.
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