Patient mix and pattern of care in hospices: Results from the National Home and Hospice Care Survey (NHHCS)

Background: Hospice care is to reduce pain and emotional hurt of patients and to improve their quality by offering a broad range of services which address patients’ needs from the following four perspectives: physical care, emotional care, social care, and spiritual care. Medicare reimburses hospices based on a fixed per diem rate, regardless of patients’ diagnosis and how much resources they will use.  Thus hospices may be less likely to admit patients who are heavy users of services. The purpose of this study is to determine the degree of hospice services provision to patients and to see if patient utilization of hospice services differed among different diagnoses.

Method: The 2007 National Home and Hospice Care Survey (NHHCS) was a cross-sectional study with the sample size of 4733 hospice discharged patients. The primary outcome variable is the number of services used by patient including core and noncore services. The key independent variable is patient disease types.

Results: In 2007, the most utilized core services was skilled nursing services (99.1%) and the most used noncore services was personal care and therapy services (80.1%). Patients who have mental disorders (e.g., dementia) utilized less number of core services when comparing to cancer patients (b=-.38).

Conclusions: Patient utilization of hospice services is different based on their disease types with cancer patient used more number of core services. Policy makers may need to consider changing the fixed per diem reimbursement method of hospice care to a more process and outcome based reimbursement rate.