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.

Hospice Industry Data from NHPCO - A Look Back Five Years

As Dr. Christian Sinclair pointed out in a recent post on the  blog Pallimed, the 2010 edition of the NHPCO report  Facts and Figures:  Hospice Care in America was short of surprises when compared to data from last year's report.

So I looked back to a 2005 report to better understand how the hospice industry has changed (or not) over the past five years. Among my surprises were these:

-Impressive growth in the percentage of decedents receiving hospice care. Sure, I expected growth, but not at the rate we've seen.

-Short-stay patients (7 days or less) remained level at one-third of total deaths and discharges. Is this an intractable issue, in which case hospices should consider improving their capacity to provide exemplary care for short-stay patients, or does there remain optimism that  knowledge of more timely (earlier) referrals will spread quickly, thus reducing the percentage of short-stay patients.

-The size of hospices remained small - nearly 8 out of 10 have fewer than three admissions per week. Given the speculative talk about consolidation, I  expected that over the past five years there would have been considerably fewer hospices admitting less that 150 patients per year.

Got me to thinking. If I was considering hospice care for a family member, aware that there is a one-in-three chance that the episode of hospice care will be no longer than a week, I'd want to select a hospice that admits ten times the number of patients than the average-sized hospice. I figure that the additional volume would mean greater proficiency in short-stay care.

Does volume matter? No studies to prove either way.
What do your professional instincts tell you?