Exploring underlying reasons for hospice disenrollment

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.