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Comments on Live Discharge Research

August 7, 2014

NHPCO Offers Comments on Research Published in Journal of Palliative Medicine

Research published today in the Journal of Palliative Medicine (Volume 17, Number 10, 2014) takes a close look at hospice patients that discontinue hospice care before their deaths – something in the profession known as live discharges. As the study authors note, “Approximately 1 in 5 hospice patients are discharged alive with variation by geographic regions and hospice programs.”

Live discharges have always been seen within hospice care in the U.S. Live discharges from hospice can occur because patients decide to resume curative care, their condition improves or stabilizes, or a patient leaves hospice care for other personal reasons that can vary. Indeed, both CMS hospice claims data and data from the hospice community  indicate that approximately 40 percent of all live discharges occur when patients, exercising their rights,  make the choice to leave hospice, for many of the reasons noted above. These new research findings, while tempered by the percentage of patients who voluntarily opt out of hospice care, raises concerns over live discharges that may reflect improper behavior on behalf of the provider.

As the author’s note, “Given the uncertainties of prognostications and the need to ensure access to high-quality care, it would be undesirable if the rate of live discharge were zero.”  It is to be expected that some patients leave hospice care. But some of the research findings point to problems among a small percentage of providers in the field, and it is important to use the data constructively.

All reputable research looking into the provision of hospice and palliative care is of immense value to the field. Dedicated researchers focused on end-of-life care should be recognized for contributions to a growing sector of healthcare in the U.S.  NHPCO data shows that more than 1.5 million dying patients are cared for every year by this nation’s hospices – a statistic that has steadily increased over the past four decades.

While hospices once cared predominantly for cancer patients at life’s end, providers now are skilled at caring for a wider range of patients with multiple complex conditions. In 2012, 63 percent of patients cared for had a non-cancer diagnoses. To see changes in care provision patterns over time should be expected to some degree.

NHPCO believes that the overwhelming majority of U.S. hospices are committed to a shared vision to bring the best that humankind can offer to all those individuals facing serious illness, death and grief. Within that vision, however, is the duty of each provider to do the best job possible to ensure that every single patient day of care is within all regulatory and legal limits.

Any hospice provider who fails to be fully compliant with all regulations and standards of practice and is unable or unwilling to provide the highest level of quality care should not be in the business of caring for the dying and their loved ones.

Over the past decade, NHPCO has led the united hospice community in the call for more consistent and timely oversight from CMS. New legislation, like the recently introduced HOSPICE Act (HR 5393) and the HELP Hospice Act of 2013 (S. 1053/H.R. 2302) call for mandated CMS surveys of hospice programs at least as frequently as every three years, which should address many of the concerns and inconsistencies raised in this new research.

As the study researchers suggest, providers with high rates of live discharges must ensure that care is consistent with patient informed preferences and they are living up the important ideals and values that are the cornerstone of hospice. 

This belief is shared by NHPCO.

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