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Hospice and managed care

J J Mahoney1

  • 1National Hospice Organization, Arlington, VA 22209, USA.

The Hospice Journal
|January 1, 1997
PubMed
Summary
This summary is machine-generated.

Managed care significantly impacts hospice care delivery, with potential reimbursement challenges and cost pressures. Strategies include defining services, clear referral criteria, per diem payments, comprehensive benefits, and flexible contracts to ensure quality hospice services.

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Area of Science:

  • Healthcare Management
  • Palliative Care
  • Health Economics

Background:

  • Managed care is increasingly influencing hospice care delivery.
  • Hospices face financial pressures due to stable or declining reimbursement rates.
  • Competition among healthcare networks may lead to hospice mergers and closures.

Purpose of the Study:

  • To analyze the effects of managed care on hospice operations.
  • To identify challenges and propose strategies for maintaining quality hospice care within managed care frameworks.
  • To address the cost-benefit pressures impacting hospice decision-making.

Main Methods:

  • Analysis of the impact of managed care on hospice reimbursement and operational models.
  • Review of strategies to align hospice services with managed care objectives.

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  • Examination of financial and service delivery pressures on hospices.
  • Main Results:

    • Managed care organizations (MCOs) exert pressure on hospices to prioritize cost-benefit analyses.
    • Potential for mergers and closures among hospices due to financial instability.
    • Need for clear operational and contractual frameworks between hospices and MCOs.

    Conclusions:

    • Defining hospice service providers and referral criteria is crucial.
    • Implementing per diem payment methods and comprehensive benefit packages is recommended.
    • Regular contract reviews and amendments are necessary for successful hospice-MCO partnerships.