Hospice care

A recent JAMA study suggests that for-profit hospices have fewer cancer patients (and thus more non-cancer patients, like heart disease and dementia) with associated longer lengths of stay, as well as fewer nurse and social worker visits. It's no secret that hospices lose money on very short-stay patients. Cancer patients are more likely to be those short stay patients, when the referral is made late in the course of the disease. Conditions such as dementia can have a less predictable course, and providers are more likely to refer to hospice earlier in the course, making the patient's case more profitable for the hospice agency. This study fundamentally goes against what most hospices I have worked with stand for, but I have not had the occasion to work with a for-profit hospice. My jaw would likely hit the ground if a hospice refused one of my referrals, assuming the patient met the Medicare criteria of having an illness which, under normal circumstances, would be terminal in 6 months or less. This study has raised the possibility that the for-profit hospices are "cherry picking" their cases to keep themselves in the black.

Smart business decisions may not always be what is in the best interest of the community or the individual patient. For me, the mutual exclusiveness of chemotherapy and hospice is a nearly insurmountable barrier to me referring my patients to hospice sooner, as much as I might like to. When you are treating dementia or heart failure, in general, you can continue the treatments currently in place while still pursuing hospice care. In cancer, you must decide to stop chemotherapy to get hospice. It can be a very difficult transition for many patients and families. (Story tip from ASCO Cancer in the News)