Policy implementation in hospice and palliative care: An examination of hospice policy, decision making and design in context of state policy on end-of-life care

Health reform and healthcare cost containment goals have placed hospice care, a form of palliative care for patients who are no longer appropriate for disease modifying therapies due to advanced or terminal illness, under increasing scrutiny. Hospice care is a comprehensive interdisciplinary care program that provides pain and symptom management as well as psychosocial, emotional, and spiritual support services to patients. The Medicare Hospice Benefit (MHB) is the primary financing mechanism for hospice care. Regular Medicare coverage is suspended for beneficiaries who elect the MHB and thereby agree to forgo curative medical treatment. Providers are reimbursed only for services that are primarily palliative and have a palliative intent.There has been rapid growth in hospice over the past decades – in 2010, 44% of Americans who died were receiving hospice (MedPac, 2012). The average length of stay rose to 86 days in 2010 up from 84 days in 2009. Research findings suggest that hospice enrollment results in substantial savings in government expenditures, in particular among short stay nursing home residents (Gozalo, Miller, Intrator, Barber & Mor, 2007). The aims of this symposium are to examine variation in state policy in hospice, palliative and end of life care, and to evaluate hospice design, policy and decision making in response to state initiatives. Research finding on State Medicaid reimbursement policies and nursing home investment in internal and external palliative care will be presented and discussed.