A National Study of Live Hospice Discharges between 2000 and 2012

Live hospice discharges represent a potential vulnerability in the Medicare hospice benefit. Little is known about how live discharges have varied over time.

To identify trends in live hospice discharges between 2000 and 2012.

Retrospective cohort study of Medicare hospice discharges.

In this study, we examined live discharges in the first six months of 2000, 2006, 2008, 2010, and 2012. A live discharge was classified as a burdensome transition if hospice discharge was followed by hospital admission, and then there was a hospice readmission within 2 days of hospital discharge. The adjusted rate of overall live discharges and burdensome transitions was examined with a multivariate mixed-effects logistic model that adjusted for age, gender, race, and hospice primary diagnosis. The model contained an interaction term for year and hospice tax status.

The unadjusted overall rate of live discharges increased from 13.7% in 2000 to 18.1% in 2012. For-profit hospice programs had an adjusted live discharge rate of 17.7% in 2000 and 22.7% in 2012. During the same period, the adjusted live discharge rate for nonprofit hospice programs increased from 15.2% to 16.3%. The overall rate of burdensome transitions increased from 2.9% in 2000 to 5.3% in 2012. Similar to the overall rate of live discharge, for-profit hospices had a higher rate of burdensome transitions (6.4%) than nonprofit hospices (4.0%) in 2012.

Live hospice discharges and burdensome transitions increased between 2000 and 2012. For-profit hospice programs demonstrated larger increases than nonprofit hospice programs.