About 1 in 5 Medicare patients is discharged from hospice care alive, whether due to patients' informed choice, a change in their condition, or inappropriate actions by the hospice to save on hospitalization costs related to terminal illness. How live discharge rates differ between hospice programs and geographic regions, and when those rates should raise red flags are among the issues explored in the article "A National Study of Live Discharges from Hospice," published in Journal of Palliative Medicine, a peer-reviewed journal from Mary Ann Liebert, Inc., publishers. The article is available free on the Journal of Palliative Medicine website until September 13, 2014.
Joan M. Teno, MD, Pedro Gozalo, PhD, and Vincent Mor, PhD, Brown University School of Public Health (Providence, RI), and Michael Plotzke, PhD, Abt Associates (Cambridge, MA), examined all of the Medicare hospice discharges in the U.S. between January 1 to December 31, 2010. For the patients discharged alive, they gathered data on survival for up to 6 months, subsequent hospitalizations, and Medicare payments during the 30 days after live hospice discharge. The authors provide details on the substantial variation they found in the rates of live discharges across states and between individual hospices, in particular comparing not-for-profit to for-profit hospice programs and more mature programs versus those that had been in operation for 5 years or less.
"The phenomenon of hospice patients 'graduating' because they get better with hospice care is well known. But, all patients discharged days to weeks before death is very strange," says Charles F. von Gunten, MD, PhD, Editor-in-Chief of Journal of Palliative Medicine and Vice President, Medical Affairs, Hospice and Palliative Medicine for OhioHealth (Columbus, OH).