BY DANIEL GAITAN | daniel@lifemattersmedia.org

Nearly 20 percent of U.S. hospice patients are discharged before death, according to new findings published in the Journal of Palliative Medicine. Not-for-profit and government-owned hospices had lower rates of live discharge than newer for-profit programs.

The researchers, led by Dr. Joan Teno, associate director of the Center for Gerontology and Health Care Research at Brown University Medical School, found that nearly 200,000 of the one million hospice patients discharged in 2010 were still alive (18 percent). Connecticut had the lowest rate of live discharge (13 percent), and Mississippi had the highest (41 percent).

“When you have a live discharge rate that is as high as 30 percent, you have to wonder whether a hospice program is living up to the vision and morality of the founders of hospice,” Teno told The Washington Post. “One part of the reason is some of the new hospice providers may not have the same values — they may be more concerned with profit margins than compassionate care.”

Patients in nonprofit programs were less likely to be discharged while alive than those in similar for-profit programs: 15 percent to 22 percent. More mature programs (those 21 years and older) had lower rates of discharge than those in operation for 5 years or less: 14 percent to 27 percent. “There has been a striking increase in the number of hospice providers with the fastest growth coming from for-profit providers,” authors write.

Hospice care is designed to help comfort the seriously ill near the end of life, and it has become increasingly popular in recent years – reaching nearly $14 billion in payments during 2011. The Medicare hospice benefit, established in 1982 to help patients pay for care, is usually provided only to those with a life expectancy of six months or less. All Medicare hospice discharges between January 1 and December 31, 2010 were analyzed.

The researchers said they are concerned by variation between hospice programs and its effect on patients’ quality-of-life.

“The provider and state variation raises concern that live discharges are not driven by patient preference but by provider and market behavior,” they add. Hospice programs that exceeded their reimbursement caps — a marker for hospices with an excessive average hospice length of stay — had double the rate of live discharges compared to hospice programs that did not exceed their cap.

One in four discharged patients were hospitalized within 30 days, and more than 7 percent were immediately hospitalized and reentered hospice.

Historically, about 15 percent of hospice patients have been discharged for a variety of reasons, including the choice to restart curative treatments. But researchers suggest some newer hospice programs have accepted patients too early and discharging others when costs of their care has risen.

In February, Illinois-based Passages Hospice, LLC was shuttered amidst federal fraud charges. The for-profit hospice, which served hundreds throughout the Midwest, allegedly over-billed Medicare and provided patients unnecessary care.

– Image courtesy Pixabay