By Rachel Dolin¹, G. Mark Holmes², Sally C. Stearns³, Denise A. Kirk⁴, Laura C. Hanson⁵, Donald H. Taylor⁶, and Pam Silberman⁷ 

Abstract

Hospice care is designed to support patients and families through the final phase of illness and death. Yet for more than a decade, hospices have steadily increased the rate at which they discharge patients before death—a practice known as “live discharge.” Although certain live discharges are consistent with high-quality care, regulators have expressed concern that some hospices’ desire to maximize profits drives them to inappropriately discharge patients. We used Medicare claims data for 2012–13 and cost reports for 2011–13 to explore relationships between hospice-level financial margins and live discharge rates among freestanding hospices. Adjusted analyses showed positive and significant associations between both operating and total margins and hospice-level rates of live discharge: One-unit increases in operating and total margin were associated with increases of 3 percent and 4 percent in expected hospice-level live discharge rates, respectively. These findings suggest that additional research is needed to explore links between profitability and patient-centeredness in the Medicare hospice program.

Published in Health Affairs, Vol.  36, No. 7