Hospices and hospitals are the two principal organizational models delivering palliative care. The Center to Advance Palliative Care (CAPC) has consistently documented, through its regular studies, the growth of hospital-sponsored palliative care services over the most recent five years. During the same period, little has changed among certified hospices.
A close look at NHPCO’s Annual Facts and Figures Reports from 2009 and 2014 tells a lot (note:2014 report, which captures data from 2013, is most recent Report published by NHPCO).
From 2009 to 2014,
- · % of decedents enrolled on hospice benefit for 7 days or less remained steady at 35%
- · median length-of-stay fell slightly to 18.5 days from 21.3
- · % of hospices with fewer than 500 admissions per year rose slightly to 79% from 77%. 45% of hospices admit fewer than 3 patients per week
- · median Average Daily Census (ADC) served by hospices increased notably, to 79.5/day, up from 60/day
- · % of total hospice billed at General Inpatient (GIP) days jumped to 4.8, up from 2.9.
So, short-stays persist, as do subscale hospices. I believe there is a correlation. And I also believe that the subscale, and highly competitive, nature of the hospice organizational structure inhibits the spread of palliative care.
On the promising side, larger hospices are getting larger. I describe this development as promising because size does bring proficiency (read this previous post on my reasoning about minimum volume thresholds).
In a 2010 post on this blog (read here), a similar five-year snapshot was taken. Taken together, one could conclude that little has changed over the past 10 years in the hospice industry.
Your thoughts and comments are invited.