Study: Hospice Enrollment Policies Roadblock Care

WIth hospice care rising 53% from 2000-2010, roughly 98% of the U.S. population lives close enough to a hospice to receive care, according to a recent study published by Health Affairs.

Although hospice services will continue experiencing demand from Americans dying each year from terminal illnesses, restrictive enrollment policies prevent many patients from receiving hospice care on the basis of eligibility. 

Taking 775 hospices operating in the U.S. from September 2008 to November 2009, the study found that 78% of hospices reported at least one restrictive enrollment policy.


The study also found that only one-third of hospices will enroll patients who are receiving chemotherapy; 50% will enroll patients receiving parenteral nutrition, and approximately two-thirds will enroll individuals who wish to continue receiving palliative radiation. 

There are two reasons mentioned for why hospices might shy away from enrolling patients.

The first being that treatments such as radiation therapy are primarily used for curative treatment, and that the Medicare hospice benefit requires patients to forgo reimbursement for such curative treatments once hospice care begins. 


Second is cost. Treatments such as chemotherapy and radiation may cost a hospice up to three times the amount of the Medicare hospice per diem reimbursement, which is a mere $140 a day, the study notes. 

Of note was the size of hospices in regards to their “open-access” policy, defined by the study as the idea that the hospice offers palliative care services to non-hospice patients. 

It was found that larger hospices consistently reported less restrictive enrollment policies compared to other hospices, the explanation being that larger patient volumes help these facilities spread the financial risk of high-cost patients across a larger patient base. 

In other words, cost averaging for these larger hospices may enable them to enroll patients requiring more costly services without drastically increasing their overall average cost per patient day, the study writes. 

“The artificial dichotomy between curative and palliative treatment, however, does not reflect the reality faced by many patients with end-stage diseases,” writes the study’s lead author Melissa Aldridge Carlson, an assistant professor of geriatrics and palliative medicine at the Mount Sinai School of Medicine in New York City. 

The fact that hospice fits the bill with the rest of the country’s health care reform ideals in that it is patient focused; uses a multidisciplinary team; it is coordinated across various settings; reduces unnecessary hospitalizations; and even helps reduce health care costs, advocates continue to call for further changes that would expand enrollment and deliver quality end-of-life services for those that need them. 

Written by Jason Oliva