Addressing long-standing racial disparities in hospice care could save Medicare as much as $270 million annually, new research has found. Outreach to underserved communities can ensure more patients receive quality care at the end-of-life as well as open untapped markets to hospice providers.
“We all know the quality of life benefits but seeing the economic potential can be helpful,” researcher Courtney Hughes, associate professor at Northern Illinois University, told Hospice News. “We looked at the Medicare population and found that if we close that gap between white individuals who elect hospice and racial ethnic minorities it would result in an additional $270 million in savings in a year.”
Nearly 87% of Medicare decedents in 2016 were caucasian, according to the National Hospice & Palliative Care Organization (NHPCO). Comparatively, slightly more than 8% were African-American; 2.1% were Hispanic, and 1.2% were Asian. That year, only 0.2% of Medicare decedents were Native American.
Due in part to lower rates of hospice utilization, Medicare spends nearly 20% more for care in the last year of life among black and Hispanic patients than white patients. Increasing hospice election among those communities would save approximately $2,105 per Medicare hospice enrollee, the study found.
For-profit hospices in general tend to do more outreach that is directed specifically towards underserved populations, data from the study indicate. This is largely due to those organizations’ larger investment in marketing.
”There are some things to learn from and emulate from the for-profit hospices that those in the administration of nonprofit hospices can think about,” Hughes said. “The outreach and marketing efforts on the for-profit side may be working really well, at least when we look at this correlation between having lower disparities in the states where there are more for-profit hospices. If there are strategies to reach populations that are underserved, then there are benefits to learning what those strategies are.”
Targeted outreach is necessary because lack of awareness or understanding of hospice is a major barrier to utilization. Some minority patients may also have a distrust of the health care system or hold cultural or religious beliefs that conflict with the idea of ending curative treatment, Hughes told Hospice News.
Educating staff about various cultural beliefs surrounding death or health care decisions can also yield benefits in terms of reaching minorities, as can attention to essential needs such as food, housing, transportation and other social determinants.
“Looking a little deeper at social determinants of health to see if there are barriers at a more basic level of income or transportation or education, for example; going upstream and seeing if that is affecting the actual hospice utilization can help as well,” Hughes said.