Hospice Enrollments From The Emergency Department Feature Short Admissions And High-Acuity Hospice Care

Medicare beneficiaries frequently visit the emergency department (ED) at the end of life, but little is known about the epidemiology of patients admitted to hospice from the ED. We used 100 percent Medicare fee-for-service claims from the period 2018-20 to describe the frequency of direct ED-to-hospice enrollments, associated patient and hospice agency characteristics, and patient outcomes. In this sample, 4.3 percent of initial enrollments in hospice originated from the ED. ED-to-hospice admissions featured short lengths-of-stay (21.7 percent were two days or less) and high rates of general inpatient level of care at the time of enrollment (23.6 percent). The 10 percent of hospice agencies with the highest proportion of ED-to-hospice enrollments were less often for-profit than agencies ranked below the fiftieth percentile in respect to proportion of ED-to-hospice enrollments. Further research is needed to increase understanding of how much patients benefit from ED-to-hospice transfers when their hospice stays before death are very short, and what drivers lead to these ED-to-hospice transfers.