TY - JOUR
T1 - Hospices' enrollment policies may contribute to underuse of hospice care in the United States
AU - Carlson, Melissa D.Aldridge
AU - Barry, Colleen L.
AU - Cherlin, Emily J.
AU - McCorkle, Ruth
AU - Bradley, Elizabeth H.
PY - 2012/12
Y1 - 2012/12
N2 - Hospice use in the United States is growing, but little is known about barriers that terminally ill patients may face when trying to access hospice care. This article reports the results of the first national survey of the enrollment policies of 591 US hospices. The survey revealed that 78 percent of hospices had at least one enrollment policy that may restrict access to care for patients with potentially high-cost medical care needs, such as chemotherapy or total parenteral nutrition. Smaller hospices, for-profit hospices, and hospices in certain regions of the country consistently reported more limited enrollment policies. We observe that hospice providers' own enrollment decisions may be an important contributor to previously observed underuse of hospice by patients and families. Policy changes that should be considered include increasing the Medicare hospice per diem rate for patients with complex needs, which could enable more hospices to expand enrollment.
AB - Hospice use in the United States is growing, but little is known about barriers that terminally ill patients may face when trying to access hospice care. This article reports the results of the first national survey of the enrollment policies of 591 US hospices. The survey revealed that 78 percent of hospices had at least one enrollment policy that may restrict access to care for patients with potentially high-cost medical care needs, such as chemotherapy or total parenteral nutrition. Smaller hospices, for-profit hospices, and hospices in certain regions of the country consistently reported more limited enrollment policies. We observe that hospice providers' own enrollment decisions may be an important contributor to previously observed underuse of hospice by patients and families. Policy changes that should be considered include increasing the Medicare hospice per diem rate for patients with complex needs, which could enable more hospices to expand enrollment.
UR - http://www.scopus.com/inward/record.url?scp=84871855728&partnerID=8YFLogxK
U2 - 10.1377/hlthaff.2012.0286
DO - 10.1377/hlthaff.2012.0286
M3 - Article
C2 - 23213153
AN - SCOPUS:84871855728
SN - 0278-2715
VL - 31
SP - 2690
EP - 2698
JO - Health Affairs
JF - Health Affairs
IS - 12
ER -