Online Program

Exploring underlying reasons for hospice disenrollment

Tuesday, November 3, 2015

Kyusuk Chung, PhD, Department of Health Sciences, California State University, Northridge, Northridge, CA
Andrew Shooshtari, BSHA, Department of Health Sciences, California State University, Northridge, Northridge, CA
Sara Rahmanian Koushkaki, BA, MSHA Candidate, Department of Health Sciences, Northridge
Medicare beneficiaries diagnosed with a terminal illness must forgo curative treatment before opting for hospice benefits. They can revoke hospice benefits for any reason and elect to return to traditional Medicare coverage. However, hospice discharges may also be initiated by the hospice. To understand situations at the time of disenrollment, we analyzed the 2007 National Home and Hospice Care Survey (NHHCS) by accounting for its complex survey design: 32% of live discharges in 2007 were due to ‘conditions stabilized or improved’; 29% were due to patient revocation for more aggressive treatment; 13% because patients moved; and as many as 27% were recorded as ‘others.’ Looking into specified reasons for ‘others’ revealed some underlying reasons for disenrollment. Categories of the specified reasons are: 1) hospices’ inability to contract with hospitals or nursing facilities as illustrated by “admitted to a non-contract hospital,” “nursing facility terminated the contract,” or “fell and broke leg and went to hospital”; 2) hospices’ inability to provide inpatient beds for inpatient hospice care as illustrated by “transferred to inpatient hospice”; 3) hospices’ inability to address crisis ahead as illustrated by “caregiver was frightened and called 911.”  These reasons suggest hospices’ inability to provide short-term inpatient care may contribute to disenrollment, requiring a call for better understanding of hospice-level factors associated with disenrollment. In particular, hospices’ ability to network with other entities should be monitored as part of Medicare routine surveillance, with Medicare policy aiming toward requiring Medicare managed care plans to offer hospice benefits to their enrollees.

Learning Areas:

Public health or related laws, regulations, standards, or guidelines

Learning Objectives:
List underlying reasons for hospice live discharges Differentiate hospice-initiated live discharges from patient-initiated live discharges Explain implications of live discharges for patient outcome measures

Keyword(s): End-of-Life Care, Data Collection and Surveillance

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been teaching long-term care courses including end-of-life care issues over the past 10 years. I have published peer-reviewed articles and presented in numerous national-level conferences.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 4097.0: Palliative Care Roundtable