Cooperation and competition at the end of life: The effects of the availability or scarcity of funding for end-of-life care on nursing homes, hospices, and palliative care organizations

As the use of hospice and palliative care has become better funded and more widely accepted in America, existing non-profit charitable hospice organizations have found themselves in an unfamiliar situation. They need to market their services and compete for insured patients, both with each other and with nursing home chains and other health organizations offering similar services. In Maryland, having a state Certificate of Need to offer hospice services in a particular county is required, but it does not guarantee equal access to potential patients. Ongoing negotiations among providers are becoming more common as they try to define their “catchment areas”, attract patients with the best insurance coverage, and not appear to abandon the uninsured.

This presentation will provide a case study description of the evolution and growth of hospice and palliative care services in Maryland over the last twenty-five years. Changing referral patterns and agreements among hospitals and hospice providers will be examined. The (nonprofit) Hospice and Palliative Care Network of Maryland's role in attempting to ease the relationships among providers and between providers and state agencies will also be analyzed. Key factors include: the ethics of providing appropriate care (with or without funding); the paths through which services are referred and/or marketed to potential patients and families; and the impact on care caused by the growing availability of multiple providers in an area.