A recent study published in the journal Health Affairs and profiled by NPR “finds that hospices with the highest rate of so-called live discharges also have the highest profits” although a cause of this was not determined. “It’s important to continue to study this area to get a better sense as to whether profits are driving the decision to discharge patients from hospice, rather than patient preferences and needs,” says Rachel Dolin, the study’s lead author.
Further, NPR found that “Government reports show that the median rate of hospice patients discharged before death has climbed steadily since at least 2000, peaking in 2012 and 2013 at almost 1 patient in 5, though more recently the percentage has declined somewhat. But the rate actually varies widely from one care organization to another. Some hospices discharge fewer than 2 percent of their patients prior to death, while others discharge more than 80 percent. Nonprofits have lower rates of live discharge than for-profit hospices. Regionally, live discharge rates are highest in the South.”
Live discharges are complicated and can occur for reasons that are not financial in nature, such as the complexity and unpredictability of certain diseases such as Alzheimer’s or Parkinson’s disease.
We recently conducted a study for a national hospice organization in which we found that hospices which exceeded the hospice cap had a live discharge rate in excess of 50%. A leading industry consultant explained that these “financially motivated” hospices would often discharge these high utilization patients around the 180 day mark. Live discharge rate is a Program for Evaluating Payment Patterns Electronic Report (PEPPER) indicator. A high live discharge rate is an indicator of possible questionable behavior.
So, where does your organization fit in terms of live discharges? And what about your competitors?
Healthcare Market Resources offers a Hospice Discharge Disposition Report which details two different areas of interest – from where was the patient referred, to what hospice were the referred and what their disposition was at time of discharge. While the discharge disposition is critical in benchmarking your agency, the source of the referral information can also be useful in understanding from where a competitor is getting business and what growth opportunities may exist. Compare your live discharge to market norms and competitors to see if anyone is skirting the edges.