Factors Driving Live Discharge From Hospice: Provider Perspectives

Area of Science:

• Healthcare Management
• Palliative Care Research

Background:

• The rate of patients disenrolling from hospice care before death has increased over the past decade.
• This trend raises concerns regarding the quality of care and potential discontinuities in patient-provider relationships.

Purpose of the Study:

• To explore hospice provider perspectives on the primary factors influencing live discharge from the Medicare hospice program.

Main Methods:

• Conducted semistructured telephone interviews with 18 individuals from 14 hospice providers nationwide.
• Utilized a template analysis approach for coding and analyzing interview transcriptions.

Main Results:

• Identified four key themes: difficulty in prognosis estimation, fear of Centers for Medicare & Medicaid Services (CMS) audits, increasing market competition, and challenges with inpatient contracting.
• Providers noted a "gray line" between appropriate and inappropriate discharges, with financial motivations sometimes influencing enrollment and disenrollment decisions.

Conclusions:

• Live discharge patterns in hospice care are significantly influenced by market dynamics and regulatory pressures.
• These external forces likely contribute to the observed increase in national live hospice disenrollment rates.