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For-profit hospice patients stayed longer, required less-skilled care
Wachterman MW. JAMA. 2011;305:472-479.
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For-profit hospice facilities had more patients diagnosed with conditions associated with lower-skilled needs or that required longer lengths of stay compared with non-profit hospice facilities, researchers have found.
Researchers used data collected from the 2007 National Home and Hospice Care Survey to study a cross-sectional sample of 4,705 patients discharged from hospice primarily due to death (84%). There were 1,087 patients (30.7%) from 145 for-profit agencies and 3,618 (69.3%) from 524 non-profit agencies.
For-profit facilities had fewer patients with cancer compared with non-profit facilities (34.1% vs. 48.4%), but for-profit facilities had a higher proportion of patients with dementia (17.2% vs. 8.4%) and other non-cancer diagnoses (48.7% vs. 43.2%).
Patients with cancer, regardless of facility, had more visits from nurses per day than those with dementia or other diagnoses (0.5 visits vs. 0.37 visits); they also had more visits from social workers (0.15 visits vs. 0.11 visits). Adjusted length of stay was 26% longer in for-profit hospices than in non-profit ones.
“The current Medicare Hospice Benefit reimburses hospices at a fixed per diem rate that does not consider the patient’s diagnosis, location of care or hospice [length of stay]. Under this system, profit can be maximized by caring for patients with certain diagnoses that require fewer skilled services, patients residing in nursing homes or patients with longer hospice stays,” researchers wrote.
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