Christian Sinclair, MD, FAAHPMUniversity of Kansas Medical CenterHospice and Palliative Medicine FellowshipJournal ClubFebruary 3rd, 2011 Free pdf avail

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Clinical Case Correlation

• Palliative Care Consult at a local hospital• Hospice referral was appropriate• Conversation with the case manager about

different agencies• Does profit status affect the care received?

Background• For-profit hospice agencies growing

• Nearly half of all hospice agencies are FP• 1660 FP agencies in 2007

• For-profit hospice agencies have higher profit margins1

• FP profit margin 12 to 16%• NP profit margin -2.9 to -4.4%

• Medicare (CMS) is gathering data to revise the payment structure for hospice benefit• Flat per-diem v. U-shaped curve• Higher costs at beginning and end of care days

1 -MedPAC Report to Congress 2008, Chapter 8

Methods

• 2007 National Home and Hospice Care Survey• 1545 agencies randomly selected

• 1036 participated• Interviewed staff and reviewed med records• 4705 patients discharged from hospice

• Due to death or live discharge

Race/Ethnicity (Table 1)

White Black Hispanic Other0

10

20

30

40

50

60

70

80

90

100

For-ProfitNon-Profit

Statistically Significant(P=.02)

Diagnosis (Table 2)

Cancer Dementia Other0

10

20

30

40

50

60

For ProfitNon Profit

Length of Stay Categories (Table 3)

<7d 7-30d 31-180d 181-364d >365d0

5

10

15

20

25

30

35

40

For ProfitNon Profit

Weak Points of Study

• Included only discharged patients• Lacked agency specific data• Lacked costs and revenues• No correlation between data and quality

of care

Conclusions

• Not sure this adds more than the MedPAC 2008 report

• Media coverage full of hyperbole

http://bit.ly/gwPoNJ

http://lat.ms/gp5oe3

Conclusions for This Study

• Not sure this adds more than the MedPAC 2008 report

• Media coverage full of hyperbole• Does this pit NP vs FP hospice agencies?

• Is this good for the field?

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