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One of Five Medicare Hospice Patients Discharged Alive – Is It to Save Money

Live discharge rates differ between hospice programs; when should those rates raise red flags among issues explored

Aug. 13, 2014 - About 1 in 5 Medicare patients is discharged from hospice care alive, whether due to patients' informed choice, a change in their condition, or inappropriate actions by the hospice to save on hospitalization costs related to terminal illness.

How live discharge rates differ between hospice programs and geographic regions, and when those rates should raise red flags are among the issues explored in the article "A National Study of Live Discharges from Hospice," published in Journal of Palliative Medicine, the peer-reviewed journal is the official journal of the Center to Advance Palliative Care (CAPC) and an official journal of the Hospice and Palliative Nurses Association.

 

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Read more Elder Care & Caregivers News

 

Joan M. Teno, MD, Pedro Gozalo, PhD, and Vincent Mor, PhD, Brown University School of Public Health (Providence, RI), and Michael Plotzke, PhD, Abt Associates (Cambridge, MA), examined all of the Medicare hospice discharges in the U.S. between January 1 to December 31, 2010.

For the patients discharged alive, they gathered data on survival for up to 6 months, subsequent hospitalizations, and Medicare payments during the 30 days after live hospice discharge.

The authors provide details on the substantial variation they found in the rates of live discharges across states and between individual hospices, in particular comparing not-for-profit to for-profit hospice programs and more mature programs versus those that had been in operation for 5 years or less.

"The phenomenon of hospice patients ‘graduating’ because they get better with hospice care is well known. But, all patients discharged days to weeks before death is very strange," says Charles F. von Gunten, MD, PhD, Editor-in-Chief of Journal of Palliative Medicine and Vice President, Medical Affairs, Hospice and Palliative Medicine for OhioHealth (Columbus, OH).

The article is available free on the Journal of Palliative Medicine website until September 13, 2014.

About the Journal
Journal of Palliative Medicine, published monthly in print and online, is an interdisciplinary journal that reports on the clinical, educational, legal, and ethical aspects of care for seriously ill and dying patients. The Journal includes coverage of the latest developments in drug and non-drug treatments for patients with life-threatening diseases including cancer, AIDS, cardiac disease; pulmonary, neurological, and respiratory conditions; and other diseases. The Journal reports on the development of palliative care programs around the United States and the world, and on innovations in palliative care education. Tables of content and a sample issue may be viewed on the Journal of Palliative Medicine website. It is published by Mary Ann Liebert, Inc., publishers.

 

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