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A National Study of Live Hospice Discharges Between 2000 and 2012 (S747)

      Objectives

      • Identify trends in live hospice discharges between 2000 and 2012.
      • Recognize factors related to live discharges and identify associated patient care concerns.

      Original Research Background

      Live hospice discharges represent a Medicare Hospice Benefit vulnerability. Little is known how discharges have varied over time by patient and provider characteristics.

      Research Objectives

      Identify trends in live hospice discharges between 2000 and 2012.

      Methods

      In this retrospective cohort study of Medicare hospice discharges, we used discharge status codes to determine whether a hospice discharge was a live discharge. Discharges in the first six months of 2000, 2006, 2008, 2010, and 2012 were examined for live discharges. Among live discharges, we identified burdensome transitions (hospice discharge followed by hospital admission, then hospice readmission). A mixed-effect multivariate logistic model was used to predict the rate of each outcome (live discharge and burdensome transition) with interaction terms for year and tax status after adjusting for patient age, gender, race, and hospice principal diagnosis.

      Results

      Between 2000 and 2012, the number of hospice programs increased from 2,233 to 3,670, with the percentage of for-profit hospices increasing from 28.2% in 2000 to 52.8% in 2012. The overall rate of live discharges increased from 13.7% in 2000 to 18.1% in 2012. Our work finds that the adjusted rate of live discharges differed by hospice tax status. For-profit hospice programs had an adjusted probability of live discharge of 17.8% in 2000 and 25.4% in 2012. Conversely, non-profit hospice programs had a modest concurrent increase in the rate of live discharge from 15.2% to 16.8%. The overall rate of burdensome transitions increased from 3.4% in 2000 to 6.4% in 2012. Similar to live discharge, for-profit hospices had a higher rate of burdensome transitions (6.2%) compared to non-profit hospices (3.6%) in 2012.

      Conclusions

      With rapid growth of for-profit hospice programs between 2000 and 2012, there has been a concurrent increase in the rate of live discharges and burdensome transitions. Much of this growth appears to be concentrated within for-profit hospice programs.