How Effective are Hospices in Spreading the Science of Palliative Care?

 Medicare-certified hospices are the principal organizational model delivering palliative care to those with life-limiting illnesses.  A close look at NHPCO's Annual Facts and Figures (2020 version recently published) reveals much about the hospice industry and the spread of the science of palliative care.

The industry continues to be subscale, hindering the development of clinical proficiency. For example, more than half of US hospices admit fewer than 2 patients per week (same as five years earlier). See here for previous blog post arguing the case that proficiency in health care is related to volume. Furthermore, more than 25% of hospices have been newly certified in the last few years, another important consideration in the development of proficiency. One might argue that the number of people utilizing the hospice benefit to receive palliative care has been growing (in 2018, more than 50% of Medicare decedents received palliative care through a certified hospice), thus justifying a greater number of hospices in the country, but the % growth in the number of hospices in the US exceeds the growth in the number of Americans utilizing the Medicare hospice benefit.  I suggest  that the large variations in late-life care will continue until the hospice industry gains in scale. (read here for more on clinical variations in late-life care).

On a more promising note from the 2020 NHPCO report, the  percentage of short-stay patients (those receiving palliative care through the hospice benefit for seven days or less) dropped to 27.9%, from 35% five years ago.  So an issue (timely use of hospice benefit) some thought intractable 10 years ago (read here) may be gradually improving.

As always, your insights and feedback are invited.