Skip to main content
SpringerLink
Log in

Hospice and Healthcare Reform: What Is the Optimal Path?

  • Chapter
  • First Online:
Meeting the Needs of Older Adults with Serious Illness

Part of the book series: Aging Medicine ((AGME))

Abstract

There is fairly universal support for improving access to high quality hospice care. Hospice is a model of health care consistent with the country’s stated healthcare reform goals: hospice is person centered, uses a multidisciplinary care team, is coordinated across settings, reduces unnecessary hospitalizations, and saves healthcare dollars. There is considerable debate, however, regarding the optimal policy and regulatory mechanisms for achieving greater access to hospice care. We begin this chapter with a discussion of the history of the hospice movement in the United States in order to provide a background in understanding the origins of the Medicare Hospice Benefit (MHB). We then discuss the target population for hospice care and the implications of expanding the MHB eligibility criteria including the likely economic consequences of these policy initiatives. We present a review of existing evidence regarding new models of care for providing hospice services that are emerging throughout the country. We conclude with a detailed discussion of what we consider actionable policy steps to increase access to and use of hospice in the United States.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Meier DE. Increased access to palliative care and hospice services: opportunities to improve value in health care. Milbank Q. 2011;89:343–80.

    Article  PubMed Central  PubMed  Google Scholar 

  2. Taylor Jr DH, Ostermann J, Van Houtven CH, Tulsky JA, Steinhauser K. What length of hospice use maximizes reduction in medical expenditures near death in the US Medicare program? Soc Sci Med. 2007;65:1466–78.

    Article  PubMed  Google Scholar 

  3. Carlson MDA, Herrin J, Du Q, et al. Impact of hospice disenrollment on health care use and medicare expenditures for patients with cancer. J Clin Oncol. 2010;28:4371–5.

    Article  PubMed Central  PubMed  Google Scholar 

  4. Wennberg JE, Fisher ES, Stukel TA, Skinner JS, Sharp SM, Bronner KK. Use of hospitals, physician visits, and hospice care during last six months of life among cohorts loyal to highly respected hospitals in the United States. BMJ. 2004;328:607.

    Article  PubMed Central  PubMed  Google Scholar 

  5. Pyenson B, Connor S, Fitch K, Kinzbrunner B. Medicare cost in matched hospice and non-hospice cohorts. J Pain Symptom Manage. 2004;28:200–10.

    Article  PubMed  Google Scholar 

  6. Teno JM, Clarridge BR, Casey V, et al. Family perspectives on end-of-life care at the last place of care. JAMA. 2004;291:88–93.

    Article  CAS  PubMed  Google Scholar 

  7. Kelley AS, Deb P, Du Q, Aldridge Carlson MD, Morrison RS. Hospice enrollment saves money for Medicare and improves care quality across a number of different lengths-of-stay. Health Aff (Millwood). 2013;32:552–61.

    Article  Google Scholar 

  8. Wright AA, Keating NL, Balboni TA, Matulonis UA, Block SD, Prigerson HG. Place of death: correlations with quality of life of patients with cancer and predictors of bereaved caregivers’ mental health. J Clin Oncol. 2010;28:4457–64.

    Article  PubMed Central  PubMed  Google Scholar 

  9. Bradley EH, Prigerson H, Carlson MDA, Cherlin E, Johnson-Hurzeler R, Kasl SV. Depression among surviving caregivers: does length of hospice enrollment matter? Am J Psychiatry. 2004;161:2257–62.

    Article  PubMed  Google Scholar 

  10. Teno JM, Shu JE, Casarett D, Spence C, Rhodes R, Connor S. Timing of referral to hospice and quality of care: length of stay and bereaved family members’ perceptions of the timing of hospice referral. J Pain Symptom Manage. 2007;34:120–5.

    Article  PubMed  Google Scholar 

  11. NHPCO facts and figures: hospice care in America. 2013. Available at: http://www.nhpco.org/sites/default/files/public/Statistics_Research/2013_Facts_Figures.pdf. Accessed November 2013.

  12. MedPac. Report to the Congress: Medicare Payment Policy: chapter 12: hospice services. 2013.

    Google Scholar 

  13. Carlson MDA, Bradley EH, Du Q, Morrison RS. Geographic access to hospice in the United States. J Palliat Med. 2010;13:1331–8.

    Article  PubMed Central  PubMed  Google Scholar 

  14. National Hospice and Palliative Care Organization. NHPCO facts and figures. 2011. Available at: http://www.nhpco.org/files/public/2011-facts-and-figures.pdf. Accessed May 2014.

  15. Teno JM, Gozalo PL, Bynum JP, et al. Change in end-of-life care for Medicare beneficiaries: site of death, place of care, and health care transitions in 2000, 2005, and 2009. JAMA. 2013;309:470–7.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  16. Jennings B, Ryndes T, D’Onofrio C, Baily MA. Access to hospice care. Expanding boundaries, overcoming barriers. Hastings Cent Rep. 2003;Suppl:S3–7, S9–13, S5–21 passim.

    Google Scholar 

  17. Foley K, Gelbard H, editors. Institute of Medicine report: improving palliative care for cancer. Washington, DC: National Academy Press; 2001.

    Google Scholar 

  18. Lynn J, Forlini JH. “Serious and complex illness” in quality improvement and policy reform for end-of-life care. J Gen Intern Med. 2001;16:315–9.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  19. Last Acts. Means to a better end: a report on dying in America today. Washington, DC: Last Acts; 2002.

    Google Scholar 

  20. Paradis LF, Cummings SB. The evolution of hospice in America toward organizational homogeneity. J Health Soc Behav. 1986;27:370–86.

    Article  CAS  PubMed  Google Scholar 

  21. James N, Field D. The routinization of hospice: charisma and bureaucratization. Soc Sci Med. 1992;34:1363–75.

    Article  CAS  PubMed  Google Scholar 

  22. Omnibus Reconciliation Act. PL101-239, Section 6005; 1989.

    Google Scholar 

  23. Jones AL. Hospices and home health agencies: data from the 1991 National Health Provider Inventory. Adv Data. 1994;(257):1–8.

    Google Scholar 

  24. Strahan GW. An overview of home health and hospice care patients: preliminary data from the 1993 National Home and Hospice Care Survey. Adv Data. 1994:1–12.

    Google Scholar 

  25. Rhodes RL, Teno JM, Welch LC. Access to hospice for African Americans: are they informed about the option of hospice? J Palliat Med. 2006;9:268–72.

    Article  PubMed  Google Scholar 

  26. Cherlin E, Fried T, Prigerson HG, Schulman-Green D, Johnson-Hurzeler R, Bradley EH. Communication between physicians and family caregivers about care at the end of life: when do discussions occur and what is said? J Palliat Med. 2005;8:1176–85.

    Article  PubMed Central  PubMed  Google Scholar 

  27. General Accounting Office. Medicare Hospice Care: modifications to payment methodology may be warranted. Washington, DC: GAO; 2004.

    Google Scholar 

  28. Friedman BT, Harwood MK, Shields M. Barriers and enablers to hospice referrals: an expert overview. J Palliat Med. 2002;5:73–84.

    Article  PubMed  Google Scholar 

  29. Wennberg JE, Fisher ES, Skinner JS. Geography and the debate over Medicare reform. Health Aff (Millwood) 2002;Suppl Web Exclusives:W96–114.

    Google Scholar 

  30. Virnig BA, Ma H, Hartman LK, Moscovice I, Carlin B. Access to home-based hospice care for rural populations: identification of areas lacking service. J Palliat Med. 2006;9:1292–9.

    Article  PubMed  Google Scholar 

  31. Virnig BA, Kind S, McBean M, Fisher E. Geographic variation in hospice use prior to death. J Am Geriatr Soc. 2000;48:1117–25.

    CAS  PubMed  Google Scholar 

  32. Virnig BA, Moscovice IS, Durham SB, Casey MM. Do rural elders have limited access to Medicare hospice services? J Am Geriatr Soc. 2004;52:731–5.

    Article  PubMed  Google Scholar 

  33. Fowler K, Poehling K, Billheimer D, et al. Hospice referral practices for children with cancer: a survey of pediatric oncologists. J Clin Oncol. 2006;24:1099–104.

    Article  PubMed  Google Scholar 

  34. Johnson CB, Slaninka SC. Barriers to accessing hospice services before a late terminal stage. Death Stud. 1999;23:225–38.

    Article  CAS  PubMed  Google Scholar 

  35. Huskamp HA, Buntin MB, Wang V, Newhouse JP. Providing care at the end of life: do Medicare rules impede good care? Health Aff (Millwood). 2001;20:204–11.

    Article  CAS  Google Scholar 

  36. Brickner L, Scannell K, Marquet S, Ackerson L. Barriers to hospice care and referrals: survey of physicians’ knowledge, attitudes, and perceptions in a health maintenance organization. J Palliat Med. 2004;7:411–8.

    Article  PubMed  Google Scholar 

  37. Christakis NA. Predicting patient survival before and after hospice enrollment. Hosp J. 1998;13:71–87.

    CAS  PubMed  Google Scholar 

  38. Zerzan J, Stearns S, Hanson L. Access to palliative care and hospice in nursing homes. JAMA. 2000;284:2489–94.

    Article  CAS  PubMed  Google Scholar 

  39. Christakis N. Death foretold: prophecy and prognosis in medical care. Chicago: University of Chicago Press; 1999.

    Google Scholar 

  40. Fox E, Landrum-McNiff K, Zhong Z, Dawson NV, Wu AW, Lynn J. Evaluation of prognostic criteria for determining hospice eligibility in patients with advanced lung, heart, or liver disease. SUPPORT Investigators Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments. JAMA. 1999;282:1638–45.

    Article  CAS  PubMed  Google Scholar 

  41. Simpson DA. Prognostic criteria for hospice eligibility. JAMA. 2000;283:2527.

    Article  CAS  PubMed  Google Scholar 

  42. Lorenz KA, Asch SM, Rosenfeld KE, Liu H, Ettner SL. Hospice admission practices: where does hospice fit in the continuum of care? J Am Geriatr Soc. 2004;52:725–30.

    Article  PubMed  Google Scholar 

  43. Casarett D, Van Ness PH, O’Leary JR, Fried TR. Are patient preferences for life-sustaining treatment really a barrier to hospice enrollment for older adults with serious illness? J Am Geriatr Soc. 2006;54:472–8.

    Article  PubMed  Google Scholar 

  44. U.S. Government Printing Office. Code of Federal Regulations 42CFR418.22, Certification of Terminal Illness; 2002.

    Google Scholar 

  45. U.S. Government Printing Office. Code of Federal Regulations 42CFR418.24, Election of Hospice Care; 2002.

    Google Scholar 

  46. Connor SR, Pyenson B, Fitch K, Spence C, Iwasaki K. Comparing hospice and nonhospice patient survival among patients who die within a three-year window. J Pain Symptom Manage. 2007;33:238–46.

    Article  PubMed  Google Scholar 

  47. Temel JS, Greer JA, Muzikansky A, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med. 2010;363:733–42.

    Article  CAS  PubMed  Google Scholar 

  48. Penrod JD, Deb P, Luhrs C, et al. Cost and utilization outcomes of patients receiving hospital-based palliative care consultation. J Palliat Med. 2006;9:855–60.

    Article  PubMed  Google Scholar 

  49. Bruera E, Neumann CM, Gagnon B, Brenneis C, Quan H, Hanson J. The impact of a regional palliative care program on the cost of palliative care delivery. J Palliat Med. 2000;3:181–6.

    Article  CAS  PubMed  Google Scholar 

  50. Fromme EK, Bascom PB, Smith MD, et al. Survival, mortality, and location of death for patients seen by a hospital-based palliative care team. J Palliat Med. 2006;9:903–11.

    Article  PubMed  Google Scholar 

  51. Center to Advance Palliative Care. Palliative care in hospitals continues rapid growth trend for 11th straight year, according to latest analysis. Available at: http://www.capc.org/news-and-events/releases/08-27-12. Accessed October 2013.

  52. Morrison RS, Maroney-Galin C, Kralovec PD, Meier DE. The growth of palliative care programs in United States hospitals. J Palliat Med. 2005;8:1127–34.

    Article  PubMed  Google Scholar 

  53. Goldsmith B, Dietrich J, Du Q, Morrison RS. Variability in access to hospital palliative care in the United States. J Palliat Med. 2008;11:1094–102.

    Article  PubMed Central  PubMed  Google Scholar 

  54. Aldridge Carlson MD, Barry CL, Cherlin EJ, McCorkle R, Bradley EH. Hospices’ enrollment policies may contribute to underuse of hospice care in the United States. Health Aff (Millwood). 2012;31:2690–8.

    Article  Google Scholar 

  55. Conversation with Bev Sloan President and CEO of The Denver Hospice; August 2013.

    Google Scholar 

  56. Thompson JW, Carlson MDA, Bradley EH. US hospice industry experienced considerable turbulence from changes in ownership, growth, and shift to for-profit status. Health Aff (Millwood). 2012;31:1286–93.

    Article  Google Scholar 

  57. Deremo D. Advanced illness management: the ‘missing piece’ in health care reform. Presented at the Center to Advance Palliative Care National Seminar, Nov 2013.

    Google Scholar 

  58. Wright AA, Katz IT. Letting go of the rope–aggressive treatment, hospice care, and open access. N Engl J Med. 2007;357:324–7.

    Article  CAS  PubMed  Google Scholar 

  59. Medicare Payment Advisory Commission. Report to the Congress: Medicare’s payment policy: reforming Medicare’s Hospice Benefit. Washington, DC: Medicare Payment Advisory Commission; 2009.

    Google Scholar 

  60. Nicosia N, Reardon E, Lorenz K, Lynn J, Buntin MB. The Medicare hospice payment system: a consideration of potential refinements. Health Care Financ Rev. 2009;30:47–59.

    PubMed  Google Scholar 

  61. Fitch K, Pyenson B. First and last days of hospice cost more: an actuarial evaluation of hospice benefits provided to Medicare Beneficiaries. New York: Milliman; 2003.

    Google Scholar 

  62. Conversation with Samira Beckwith of Hope HealthCare Services; Sept 2013.

    Google Scholar 

  63. Centers for Medicaid & Medicare Services. Medicare and Medicaid Programs: hospice conditions of participation; Final Rule. 42CFRPart418 2008;73.

    Google Scholar 

  64. Taylor DH, Steinhauser K, Tulsky JA, Rattliff J, Van Houtven CH. Characterizing hospice discharge patterns in a nationally representative sample of the elderly, 1993–2000. Am J Hosp Palliat Care. 2008;25(1):9–15.

    Google Scholar 

  65. Casarett DJ, Marenberg ME, Karlawish JH. Predictors of withdrawal from hospice. J Palliat Med. 2001;4:491–7.

    Article  CAS  PubMed  Google Scholar 

  66. Carlson MDA, Herrin J, Du Q, et al. Impact of hospice disenrollment on health care use and Medicare expenditures for patients with cancer. J Clin Oncol. 2010;28(28):4371–75.

    Google Scholar 

  67. Johnson KS, Kuchibhatla M, Tanis D, Tulsky JA. Racial differences in hospice revocation to pursue aggressive care. Arch Intern Med. 2008;168:218–24.

    Article  PubMed  Google Scholar 

  68. Carlson MDA, Herrin J, Du Q, et al. Hospice characteristics and the disenrollment of patients with cancer. Health Serv Res. 2009;44:2004–21.

    Article  PubMed Central  PubMed  Google Scholar 

  69. Aldridge MD, Schlesinger M, Barry CL, et al. National hospice survey results: for-profit status, community engagement, and service. JAMA Intern Med. 2014;174(4):500–6.

    Google Scholar 

  70. Medicare Payment Advisory Commission. Report to the Congress: reforming the delivery system, Chap. 8: Evaluating Medicare’s Hospice Benefit: Washington, DC; 2008.

    Google Scholar 

  71. Carlson MDA, Morrison RS, Holford TR, Bradley EH. Hospice care: what services do patients and their families receive? Health Serv Res. 2007;42:1672–90.

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA

    Melissa D. Aldridge Ph.D., M.B.A.

  2. Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA

    Jean S. Kutner M.D., M.S.P.H.

Authors
  1. Melissa D. Aldridge Ph.D., M.B.A.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jean S. Kutner M.D., M.S.P.H.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Melissa D. Aldridge Ph.D., M.B.A. .

Editor information

Editors and Affiliations

  1. Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA

    Amy S. Kelley

  2. Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA

    Diane E. Meier

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer Science+Business Media New York

About this chapter

Cite this chapter

Aldridge, M.D., Kutner, J.S. (2014). Hospice and Healthcare Reform: What Is the Optimal Path?. In: Kelley, A., Meier, D. (eds) Meeting the Needs of Older Adults with Serious Illness. Aging Medicine. Humana Press, New York, NY. https://doi.org/10.1007/978-1-4939-0407-5_5

Download citation

  • DOI: https://doi.org/10.1007/978-1-4939-0407-5_5

  • Published:

  • Publisher Name: Humana Press, New York, NY

  • Print ISBN: 978-1-4939-0406-8

  • Online ISBN: 978-1-4939-0407-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation