Major Disparities Between For-Profit and Nonprofit Hospice Detailed in National Survey
Mount Sinai researchers flag less training and research, higher hospice disenrollment, exceeding medicare’s aggregate cap more often in for-profits.
In one of the first studies to look at the impact of for-profit versus nonprofit hospice status, researchers from the Icahn School of Medicine at Mount Sinai found that for-profit hospices were more likely to serve patients in nursing homes and assisted living facilities than in the patients’ own homes; were three times as likely to exceed Medicare’s annual reimbursement cap; and provide far less training and research opportunities than at nonprofit hospices. The study, titled "National Hospice Survey Results – For-Profit Status, Community Engagement and Service," was published online in JAMA Internal Medicine and was led by Melissa D. Aldridge, PhD, Associate Professor of Geriatrics and Palliative Medicine at the Icahn School of Medicine at Mount Sinai, in conjunction with Elizabeth Bradley, PhD, Professor of Public Health and Director, Yale Global Health Initiative at the Yale School of Public Health.
The results of this study suggest that for-profit and nonprofit hospices differ in a broad range of activities at the patient, family and community levels, noted Dr. Aldridge. "Our findings indicate that for-profit hospices were less involved in training and research (55% vs. 82% and 18% vs. 23% respectively), disenrolled patients prior to death at higher rates, and exceeded Medicare’s aggregate annual cap, at 22% versus 4%. The for-profit hospices were also less likely to partner with oncology centers."
For-profit hospices did report greater outreach to low-income (61% vs. 46%) and minority (59% vs. 48%) communities, which the authors say might point to greater use of hospice among these populations and reduction in disparities of care.
"We need greater oversight of activities such as patient disenrollment from hospice, especially given that we know disenrollment is associated with poor outcomes for patients and families," added Dr. Aldridge.
R. Sean Morrison, MD, Director of the Lilian and Benjamin Hertzberg Palliative Care Institute, Director of the National Palliative Care Research Center and Professor of Geriatrics, Palliative and Internal Medicine at the Icahn School of Medicine at Mount Sinai, stressed the importance of addressing the marked shift in ownership of hospice towards for-profits. "Hospices have been important sites for clinical training and research focused on improved care of the dying. As the population ages, more people will need hospice care and more health care professionals will need the knowledge and training that hospice provides. The loss of these training opportunities accompanying the growth of for-profit hospice is concerning." said Dr. Morrison.
Between 2000 and 2009, for-profit hospices--once a minor player in the US hospice market -- accounted for 4 of 5 hospices entering the market. By 2011, about 51% of hospices across the United States were for-profit hospices.
The National Hospice Survey was a national cross-sectional survey with information from 591 hospices across the United States. A strength of the study was its 84% response rate, a rate that is often difficult to achieve in survey data. Elizabeth Bradley, PhD, from Yale University, was the principal investigator of the National Hospice Study. Other study investigators are at Johns Hopkins School of Medicine, Baltimore, MD, and The Hospice Institute for Education, Training and Research, Inc.
Funding for the study was provided by grants from the National Cancer Institute, the National Institute on Aging, the John D. Thompson Foundation, the National Institute of Nursing Research, and the National Palliative Care Research Center.
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