Post-acute discharges into hospice have been on the rise during the last four years, but more patients need it than are receiving it, recent research has found. The demand for hospice coupled with under-utilization indicates a need for increased physician education about these services, particularly those in the acute care space.
The number of patients who received post-acute discharge instructions that included hospice increased from 3.1% in 2016 to 4.0% in 2020, according to a Trella Health study. The slight jump could be related to growing efforts to promote hospice utilization when appropriate, findings indicated. Providers supplying the discharge instructions were hospitals, home health agencies and long term care or skilled nursing facilities.
Despite rising hospice utilization nationwide, a much higher number of patients seek out this care than who actually receive physician instructions for it, Trella reported. This may indicate the need for more education for physicians around accurately identifying patients that are appropriate for hospice care.
“Hospice is growing but it’s still underutilized. Physician education is becoming increasingly accepting of end-of-life care and identifying where it’s appropriate, but there’s still more that can be done,” Carter Bakkum, senior data analyst of health care insight at Trella Health, told Hospice News. “It’s likely these patients could have been referred to hospice care directly after discharge from an acute care setting, so there may be a knowledge gap on the hospital providers in identifying patients who are appropriate for hospice care.”
The COVID-19 pandemic likely had an impact on the rise in patients receiving discharge instructions for hospice, according to Bakkum. Many patients avoided facility-based care due to fears of acquiring the virus. With elective procedures and some other services cancelled, the patients who did enter the hospital were those in need of emergency or mandatory care. Because only the sickest patients were likely to be admitted, more of them were appropriate for post-acute care, Bakkum said.
Post-acute care is a growing set of services that accounts for more than $2.7 trillion spent on personal health costs as well as nearly 15% of total Medicare spending, according to data from the American Hospital Association.
Hospice is growing in the post-acute space. Hospice utilization among Medicare decedents in 2019 rose to a new record of 51.6%, up from 50.6% in 2018, according to the Medicare Payment Advisory Commission (MEDPAC). Despite rising utilization, hospice remains largely misunderstood, with misconceptions about end-of-life proliferating throughout the health care system and the general population a common barrier to these services.
A mere 7% of eligible patients were referred for early hospice care in 2020, reported Trella Health in a separate report, indicating a “significant opportunity for many providers to positively impact patients’ end-of-life care” with improved outcomes and reduced health care costs.
Nearly 54% Medicare decedents received hospice care for 30 days or less in 2018, according to a new report from the National Hospice & Palliative Care Organization (NHPCO). About 28% percent of those beneficiaries were in hospice for seven days or less, which is considered too short a period for patients to fully benefit, NHPCO indicated.
Increasing awareness of the need for end-of-life care could lead to more acceptance of hospice care in general and in turn higher referral rates, according to Bakkum.
“Hospice providers may want to focus on how to train their top referring providers to identify patients appropriate for hospice care,” Bakkum said. “More discharges with hospice instructions means more patients hospice agencies could receive.”
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