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 Hospice ‘Penetration’ Lowers Hospitalizations For Even Non-Hospice Residents

Widespread hospice care appears to reduce the number of hospitalizations even for those residents who don’t elect to use hospice, a new study claims.

Studying the last days of thousands of Medicare patients, a five-person research team found that the more commonly hospice was offered in nursing homes, the more hospitalizations for all residents decreased. For every 10 percent increase in hospice “penetration” of nursing homes, the risk of hospitalizations for all residents—those in hospice care and those in other care—fell by almost 5 percent, the researchers say.

“Given that hospitalizations in nursing home residents are responsible for a considerable portion of Medicare cost,” lead researcher Nan Tracy Zheng writes for the team, “our findings can contribute to a more comprehensive and complete understanding of hospice’s effect on government health care expenditures.”

The study, the first of its kind, was published in the latest issue of the Journal of the American Medical Directors Association. It comes on the heels of a report by the Department of Health and Human Services Office of Inspector General that found Medicare hospice expenses in assisted living centers had more than doubled over five years, to $2.1 billion in 2012. The inspector general warned federal regulators that hospice providers may “target beneficiaries with certain diagnoses and those likely to have long stays” as a way to game the system.

But Zheng’s findings suggest that, given the “sizable spill-over effect” they’ve seen of hospice in nursing homes, regulators may be too myopic. Zheng suggests further study, focusing on hospice care in individual facilities, and comparing spending on non-hospice residents “across facilities with various hospice penetrations.”

On average, more than 28 percent of Medicare residents in skilled nursing centers choose hospice during their last 30 days, Zheng and colleagues found. Of those who choose hospice, nearly a quarter make at least one trip to the hospital, but nearly two-fifths of those who don’t choose hospice are hospitalized, the study found.

The researchers speculate that the spill-over effect may come from nursing home staff, whose “exposure to palliative care provided by hospice staff may influence the way in which nursing home staff care for end-of-life residents.”

“More exposure to the provision of palliative care may improve nursing home staff competencies in providing such care to all residents,” Zheng says. “Thus, the spill-over effect may improve end-of-life care for non-hospice residents.”

Bill Myers is Provider’s senior editor. Email him at Follow him on Twitter, @ProviderMyers.
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