Factors Driving Live Discharge From Hospice: Provider Perspectives

Abstract Context The proportion of patients disenrolling from hospice before death has increased over the decade with significant variations across hospice types and regions. Such trends have raised concerns about live disenrollment's effect on care quality. Live disenrollment may be driven by factors other than patient preference and may create discontinuities in care, disrupting ongoing patient-provider relationships. Researchers have not explored when and how providers make this decision with patients. Objective The objective of this study was to ascertain provider perspectives on key drivers of live discharge from the Medicare hospice program. Methods We conducted semistructured telephone interviews with 18 individuals representing 14 hospice providers across the country. Transcriptions were coded and analyzed using a template analysis approach. Results Analysis generated four themes: 1) difficulty estimating patient prognosis, 2) fear of Centers for Medicare & Medicaid Services audits, 3) rising market competition, and 4) challenges with inpatient contracting. Participants emphasized challenges underlying each decision to discharge patients alive, stressing that there often exists a gray line between appropriate and inappropriate discharges. Discussions also focused on scenarios in which financial motivations drive enrollment and disenrollment practices. Conclusion This study provides significant contributions to existing knowledge about hospice enrollment and disenrollment patterns. Results suggest that live discharge patterns are often susceptible to market and regulatory forces, which may have contributed to the rising national rate.   Factors Driving Live Discharge From Hospice: Provider Perspectives Dolin, Rachel et al. Journal of Pain and Symptom Management , Volume 53 , Issue 6 , 1050 -...

The Dubious Empirical and Legal Foundations of Wellness Programs

Abstract The article offers information on the dubious empirical and legal foundations of workplace wellness programs in the U.S. Topics discussed include enactment of Affordable Care Act for expanding the scope of incentives availas; analysis of financial incentives offered to the employees for encouraging their participation in wellness programs; and targeting incentives specifically toward individuals diagnosed with chronic diseases. Source: Adrianno McIntyre, Nicholas Bagley, Austin Frakt, and Aaron Carroll, The Dubious Empirical and Legal Foundations of Wellness Programs, 27 Health Matrix 59 (2017) Available at:...

BOOK REVIEWS: Our Health Care Tug-of-War

Steven Brill makes some keen points about what works—and what doesn’t—in our health care system. He’s not so good on what will fix it. BY ADRIANNA MCINTYRE FROM SUMMER 2015, NO. 37 America’s Bitter Pill: Money, Politics, Backroom Deals, and the Fight to Fix Our Broken Healthcare System By Steven Brill • Random House • 2015 • 528 pages • $28 Several weeks after the disastrous October 1, 2013, launch of Healthcare.gov, I had dinner with friends who also happened to be reporters on the health-care beat. “We knew it was going to be bad,” one person at the table remarked grimly. “But did we know it was going to be this bad?” On the first day that the federal insurance exchange was online, just six people were able to register for coverage. The site struggled to work for months. But when open enrollment finally ended in April 2014, after several extensions from the Administration, more than eight million people had found coverage through the state and federal insurance exchanges, surpassing projections from the Congressional Budget Office. In America’s Bitter Pill, Steven Brill deftly chronicles this disaster and recovery with a depth of reporting that day-to-day coverage didn’t provide. With the benefit of hindsight and the space of 455 pages of text, Brill is able to trace the stubborn and complex confluence of pressures, inescapable trade-offs, and fallible actors that brought us the nation’s most sweeping health reform in half a century. But Brill, the celebrated investigative journalist, proves to be fallible, too: Rather than stick to reporting, he chooses to play pundit and issue ill-informed prescriptions for our health-care system. His recommendations demonstrate a...