Key Research Trends: Long Hospice Stays, Palliative Care Save Medicare Dollars

The health care space — including hospice — is increasingly shaped by numbers.

During the past several years hospice providers have had to become experts in data management in order to remain competitive. Data has become invaluable to negotiations with referral and payer sources, as well as to regulatory compliance.

But providers can also benefit from considering data that comes from outside their organizations to identify prevailing trends, inform their marketing efforts and guide their decision making.

This is the first of a two-part service that will detail key findings from recent research on hospice care, featuring numbers that could influence they ways hospices communicate and operate.

Hospices’ cost-savings potential

A study published in March revealed that hospice saved Medicare roughly $3.5 billion for patients in the last year of life, a 3.1% reduction.

Moreover, hospice stays that extended beyond six months generated the highest percentage of savings at 11%.

The data show the value of longer stays at a time when regulators are raising more questions about the duration of hospice care and what it means for eligibility. The U.S. Centers for Medicare & Medicaid Services (CMS) has been zeroing in on long lengths of stay as a potential red flag, one that could suggest a hospice admitted someone who was not truly eligible.

Additionally, the U.S. Department of Health & Human Services Office of the Inspector General (OIG) has planned a national audit on hospice eligibility this year, which will include examination of patients’ length of stay.

In light of these pressures, industry stakeholders and providers alike are increasingly urging regulators to consider “modernizing” the parameters of the hospice benefit to reflect the aging population’s changing needs.

“There are all sorts of ways of looking at doing things differently in the future,” Alivia Care CEO Susan Ponder-Stansel told Hospice News. “We can provide better care to patients with advanced and serious illness, and it’s encouraging to see research show what changes could come in hospice.”

The findings were published by a trio of organizations, the National Hospice and Palliative Care Organization (NHPCO), the National Association for Home Care & Hospice (NAHC) and NORC at the University of Chicago.

The data will inform continuing discussions of the disconnect between the ways providers perceive hospice lengths of stay and the views of regulators.

“Hospice is associated with lower Medicare end-of-life expenditures when hospice lengths of stay are longer than 10 days,” an NHPCO representative told Hospice News in an email. “In other words, earlier enrollment in hospice reduces Medicare spending even further.”

Educating patients about their end-of-life care options could lead to more patients choosing hospice sooner in their disease trajectories, which would create further savings for Medicare and reduce expensive medical interventions, according to an NHPCO fact sheet.

“This study confirms that hospice care adds value to patients, family members, and caregivers by increasing satisfaction and quality of life, improving pain control, and reducing both physical and emotional distress in patients and prolonged grief and other emotional distress in their family and caregivers,” NHPCO indicated. “There is a substantial opportunity to further explore what health care utilization, diagnoses, and changing frailty represent for mortality risk and prediction of hospice use.”

Expanded palliative care boosts hospice enrollment

In recent years, hospices have increasingly diversified their service lines to include palliative care programs. A growing body of research is showing the potential return on investment of these efforts.

More than half (56%) of nearly 330 hospice professionals indicated that their organizations planned to launch palliative care programs for the first time during 2023 in this year’s Hospice News’ Industry Outlook Survey, prepared in collaboration with Homecare Homebase. This marks a climb from 52% last year.

Recent data has found that seriously ill patients receiving palliative care services are more likely to choose hospice at the end of life.

Recent research from analysts at the Center for Medicare & Medicaid Innovation (CMMI) found that when deployed at scale, palliative care can help achieve many of the health care systems current goals, including reduced costs, improved patient satisfaction and quality of life. CMMI analysts examined four payment model demonstrations to determine current barriers to palliative care access and utilization.

Another study, published in June, found that — among 180 hospitalized cancer patients in Israel — those who saw a palliative social worker, psychologist or chaplain were more likely to forgo aggressive treatments and choose hospice.

These studies are the latest in a string that have found that upstream palliative care can increase hospice utilization.

Last year a study from Northern Illinois University and Seattle University indicated that access to community-based palliative care increases the likelihood that patients will receive end-of-life care in their homes. 

After examining several databases, researchers also found that these services generated health care costs savings through reductions in high-acuity care and hospitalizations.

Studies like these show the value proposition of hospices’ integrating palliative services into their care repertoire, according to Dr. Andrew Mayo, chief medical officer of St. Croix Hospice. The data also point to where and how palliative could fit into future reimbursement in hospice and beyond, Mayo indicated.

“It’s thinking about applying those [studies’] principles common to hospice and palliative care and moving them upstream,” Mayo said at the Hospice News Palliative Care Conference. “Studies are going to be very powerful in moving the needle to integrate palliative care not only in defining programs hopefully someday by Medicare, but also for innovative systems that are bringing new payment models and new relationships to provide this interdisciplinary care to patients. And that’s where the rubber hits the road: What do we do for patients? How do we provide the best care possible for a patient?”