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Christian Sinclair, MD, FAAHPMUniversity of Kansas Medical CenterHospice and Palliative Medicine FellowshipJournal ClubFebruary 3rd, 2011 Free pdf avail
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Clinical Case Correlation
• Palliative Care Consult at a local hospital• Hospice referral was appropriate• Conversation with the case manager about
different agencies• Does profit status affect the care received?
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Background• For-profit hospice agencies growing
• Nearly half of all hospice agencies are FP• 1660 FP agencies in 2007
• For-profit hospice agencies have higher profit margins1
• FP profit margin 12 to 16%• NP profit margin -2.9 to -4.4%
• Medicare (CMS) is gathering data to revise the payment structure for hospice benefit• Flat per-diem v. U-shaped curve• Higher costs at beginning and end of care days
1 -MedPAC Report to Congress 2008, Chapter 8
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Methods
• 2007 National Home and Hospice Care Survey• 1545 agencies randomly selected
• 1036 participated• Interviewed staff and reviewed med records• 4705 patients discharged from hospice
• Due to death or live discharge
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Race/Ethnicity (Table 1)
White Black Hispanic Other0
10
20
30
40
50
60
70
80
90
100
For-ProfitNon-Profit
Statistically Significant(P=.02)
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Diagnosis (Table 2)
Cancer Dementia Other0
10
20
30
40
50
60
For ProfitNon Profit
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Length of Stay Categories (Table 3)
<7d 7-30d 31-180d 181-364d >365d0
5
10
15
20
25
30
35
40
For ProfitNon Profit
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Weak Points of Study
• Included only discharged patients• Lacked agency specific data• Lacked costs and revenues• No correlation between data and quality
of care
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Conclusions
• Not sure this adds more than the MedPAC 2008 report
• Media coverage full of hyperbole
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Conclusions for This Study
• Not sure this adds more than the MedPAC 2008 report
• Media coverage full of hyperbole• Does this pit NP vs FP hospice agencies?
• Is this good for the field?
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• Christian Sinclair, MD, FAAHPM
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