Featured Research

from universities, journals, and other organizations

Nonprofit hospices disproportionately care for costly patients, researchers conclude

Date:
February 1, 2011
Source:
Beth Israel Deaconess Medical Center
Summary:
For-profit hospice agencies had a higher percentage of patients with diagnoses associated with less skilled care and longer lengths of stay in hospice, than their nonprofit counterparts, a difference that may leave "nonprofit hospice agencies disproportionately caring for the most costly patients," researchers report.

For-profit hospice agencies had a higher percentage of patients with diagnoses associated with less skilled care and longer lengths of stay (LOS) in hospice, than their nonprofit counterparts, a difference that may leave "nonprofit hospice agencies disproportionately caring for the most costly patients," Beth Israel Deaconess Medical Center researchers report.

The findings appear in the Feb.2 issue of the Journal of the American Medical Association (JAMA).

"There was a big increase in the number of for-profit hospice agencies from 2000 to 2007, and previous work has shown that those agencies tended to have significantly higher profit margins than their nonprofit counterparts," said lead author, Melissa W. Wachterman, MD, MPH, a palliative care physician and research fellow in BIDMC's Division of General Medicine and Primary Care. "The Medicare per diem payment rate is the same, regardless of patient diagnosis, location in which care is received (for example, private home versus nursing home), or length of stay, and we wanted to know whether for-profit and nonprofit hospices were responding differently to potential financial incentives inherent in the Medicare Hospice Benefit."

Researchers examined a nationally representative sample of patients discharged from hospice, primarily due to death (85 percent) in 2007. In all, data from 4,705 patients, representing an estimated 1.03 million patients discharged from hospice nationwide, were analyzed, looking at diagnosis, location of care, length of stay, and number of visits per day by different hospice care providers.

The data showed that nonprofit hospice agencies had a higher proportion of the types of patients who required more visits from skilled care providers than for-profit agencies. For example, nonprofit agencies had a higher proportion of cancer patients, while for-profit agencies had a higher proportion of dementia patients. Cancer patients required more visits per day from skilled personnel such as nurses and social workers than patients with dementia. Wachterman explains that patient selection of this nature has important policy implications because caring for dementia patients rather than cancer patients "could be financially advantageous for hospices under the current capitated reimbursement system."

However, it is important to note that "clinicians caring for patients considering hospice can be reassured that for-profit hospices provide as many nursing visits to patients with a given diagnosis as nonprofit hospices," adds senior author Ellen McCarthy, PhD, MPH, an epidemiologist at BIDMC and a professor of medicine at Harvard Medical School.

The study also looked at length of stay and found that the median LOS for patients in for-profit hospice agencies was four days longer when compared with nonprofit hospice agencies. Because there are considerable fixed costs at the time of enrollment in hospice and again at the time of death, longer stays are "thought to be more profitable," the study noted.

The significant differences between for-profit and nonprofit hospice agencies mean that hospices serving the neediest patients "may face difficult financial obstacles to providing appropriate care in this fixed per-diem payment system," explains Wachterman.

These findings may "have potentially important implications both for clinicians taking care of patients at the end of life and for policymakers in the area of Medicare hospice payment." The study may help inform current debate around payment reform in the Medicare Hospice Benefit.

The Medicare Payment Advisory Committee (MedPAC) has recommended a U-shaped reimbursement plan that considers the intensity of care required at the beginning and end of a hospice stay. The plan also recommends that a higher per diem rate be paid for the first 30 days of enrollment and a standard payout be made at the time of death.

Study coauthors include BIDMC investigators Edward R. Marcantonio, MD, SM and Roger B. Davis, ScD. This study was supported through funding from the Health Resources and Services Administration of the Department of Health and Human Services to support the Harvard Medical School Fellowship Program in General Medicine and Primary Care.

The study was deemed exempt by the Beth Israel Deaconess Medical Center institutional review board because the researchers used publicly available deidentified data.


Story Source:

The above story is based on materials provided by Beth Israel Deaconess Medical Center. Note: Materials may be edited for content and length.


Journal Reference:

  1. M. W. Wachterman, E. R. Marcantonio, R. B. Davis, E. P. McCarthy. Association of Hospice Agency Profit Status With Patient Diagnosis, Location of Care, and Length of Stay. JAMA: The Journal of the American Medical Association, 2011; 305 (5): 472 DOI: 10.1001/jama.2011.70

Cite This Page:

Beth Israel Deaconess Medical Center. "Nonprofit hospices disproportionately care for costly patients, researchers conclude." ScienceDaily. ScienceDaily, 1 February 2011. <www.sciencedaily.com/releases/2011/02/110201163918.htm>.
Beth Israel Deaconess Medical Center. (2011, February 1). Nonprofit hospices disproportionately care for costly patients, researchers conclude. ScienceDaily. Retrieved July 31, 2014 from www.sciencedaily.com/releases/2011/02/110201163918.htm
Beth Israel Deaconess Medical Center. "Nonprofit hospices disproportionately care for costly patients, researchers conclude." ScienceDaily. www.sciencedaily.com/releases/2011/02/110201163918.htm (accessed July 31, 2014).

Share This




More Health & Medicine News

Thursday, July 31, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

House Republicans Vote to Sue Obama Over Healthcare Law

House Republicans Vote to Sue Obama Over Healthcare Law

Reuters - US Online Video (July 31, 2014) The Republican-led House of Representatives votes to sue President Obama, accusing him of overstepping his executive authority in making changes to the Affordable Care Act. Mana Rabiee reports. Video provided by Reuters
Powered by NewsLook.com
Despite Health Questions, E-Cigs Are Beneficial: Study

Despite Health Questions, E-Cigs Are Beneficial: Study

Newsy (July 31, 2014) Citing 81 previous studies, new research out of London suggests the benefits of smoking e-cigarettes instead of regular ones outweighs the risks. Video provided by Newsy
Powered by NewsLook.com
Dangerous Bacteria Kills One in Florida

Dangerous Bacteria Kills One in Florida

AP (July 31, 2014) Sarasota County, Florida health officials have issued a warning against eating raw oysters and exposing open wounds to coastal and inland waters after a dangerous bacteria killed one person and made another sick. (July 31) Video provided by AP
Powered by NewsLook.com
Health Insurers' Profits Slide

Health Insurers' Profits Slide

Reuters - Business Video Online (July 30, 2014) Obamacare-related costs were said to be behind the profit plunge at Wellpoint and Humana, but Wellpoint sees the new exchanges boosting its earnings for the full year. Fred Katayama reports. Video provided by Reuters
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins