Hospice Underutilization in the U.S.: The Misalignment of Regulatory Policy and Clinical Reality

Journal of Pain and Symptom Management
Perry G Fine

Abstract

After three and a half decades of experience with the Medicare hospice benefit in the U.S., despite excellent quality outcomes in symptom management, patient and family satisfaction, and reduction in health care costs, only 12%-15% of beneficiaries' days during the last year of life are spent being cared for within the highly cost-effective interdisciplinary coordinated advanced illness care model known as hospice. Although there are many reasons for this, including difficulties in acknowledging mortality among patients, their families, and physicians, a significant cause of low overall hospice utilization and intractably low median lengths of stay, reflective of late admissions, can be attributed to increasingly difficult and highly variable prognostic determinations for most of the leading causes of death among Medicare beneficiaries. Medicare is the payer for most hospice care in the U.S. and requires certification of a prognosis of six months or less for a beneficiary to access hospice support. At the time of admission to hospice, two physicians must predict that a patient is more likely to die in the next six months than survive, based on clinical status. In addition to prognostic uncertainty constituting a barrier to time...Continue Reading

References

Sep 8, 1998·The American Journal of Hospice & Palliative Care·R S SchonwetterA E Thal
Apr 6, 2001·The Western Journal of Medicine·T J Iwashyna, N A Christakis
Apr 16, 2003·The American Journal of Hospice & Palliative Care·Ronald S SchonwetterWilliam E Haley
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Aug 24, 2016·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·Jennifer S TemelJoseph A Greer

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Citations

Nov 2, 2019·The American Journal of Hospice & Palliative Care·Robert F Johnson
Mar 12, 2020·Journal of General Internal Medicine·Nishant SahniGyorgy Simon
Oct 24, 2020·Supportive Care in Cancer : Official Journal of the Multinational Association of Supportive Care in Cancer·Elleana J MajdinasabKevin Y Pei
Nov 14, 2020·JCO Oncology Practice·Mihir N PatelArif H Kamal
Feb 21, 2021·Journal of the American Geriatrics Society·Elizabeth A LuthHolly G Prigerson
Aug 31, 2020·Cardiovascular Revascularization Medicine : Including Molecular Interventions·Muhammad Zia KhanMuhammad Bilal Munir

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