Impact of Medicare certification on the hospice movement

This paper examines the effect of hospice Medicare legislation on the hospice movement by interpreting interviews with all 26 hospice directors in Missouri. The four directors who were planning to apply for Medicare certification were associated with hospices that differed from the hospices of the other 19 directors who did not plan to apply. The hospices that were applying for Medicare certification had a larger caseload, had been in operation longer, had goals and current operations more consistent with the rules of Medicare, and anticipated the need for additional funds. Hospice affiliation was not a good predictor of other hospice characteristics and whether or not the director was planning to apply for Medicare certification. The hospice director's reactions to the impact of Medicare on the hospice movement in general is discussed. Even though most of the directors did not plan to apply for certification, the hospice movement may be forced to become standardized and bureaucratized.