Hospice: Philosophy of care and appropriate utilization in the United States
- Diane E Meier, MD, FACP
Diane E Meier, MD, FACP
- Director, Center to Advance Palliative Care
- Director, Hertzberg Palliative Care Institute, Mount Sinai School of Medicine
- Professor, Geriatrics and Internal Medicine, Mount Sinai School of Medicine
- Elizabeth McCormick, MD
Elizabeth McCormick, MD
- Assistant Professor of Geriatrics and Palliative Medicine
- Mount Sinai School of Medicine
- Ruth L Lagman, MD, MPH, FACP, FAAHPM
Ruth L Lagman, MD, MPH, FACP, FAAHPM
- The Harry R. Horvitz Center for Palliative Medicine and Supportive Oncology
- Taussig Cancer Institute
- Cleveland Clinic
Hospice care is a model and philosophy of care that focuses on palliating terminally ill patient’s pain and other symptoms, and attending to their and their family’s emotional and spiritual needs.
The concept of hospice started during the middle ages when hospices were set up as places of rest for pilgrims and other travelers. At the end of the 19th century, hospices were designated specifically to care for the dying, first in Ireland and later in England. St. Christopher’s Hospice in London opened in 1967 under the direction of Dr. Cicely Saunders. A nurse, social worker, and a physician, Saunders developed and advanced the modern hospice movement to reflect her commitment to patient-centered care, pain management, research, and education. The philosophy and practice of the St. Christopher’s Hospice program has since spread to all countries in the developed world and to many developing countries.
Hospice services are designed to provide comprehensive interdisciplinary team-based palliative care for patients with life-limiting illness and a prognosis of six months or less if the disease follows its natural course. Hospice services in the United States (US) are an insurance benefit reimbursed by Medicare, Medicaid, and other payers.
In the US, hospice was initially a grass roots and volunteer response to bring attention to the needs of the dying, with the goal of providing patient-centered care and avoiding unnecessary medical intervention. In 1982, the Medicare hospice benefit was authorized under part A of the Medicare program .
The past two decades have seen a dramatic increase in the number of hospice programs internationally and within the US. For example, in the US [2,3]:
- National Hospice and Palliative Care Organization: History of Hospice Care http://www.nhpco.org/i4a/pages/index.cfm?pageid=3285 (Accessed on March 17, 2011).
- MedPAC. Report to the Congress: Medicare Payment Policies (March 2010) 2010:148.
- NHPCO Facts and Figures on Hospice. Released September 2015. http://www.nhpco.org/hospice-statistics-research-press-room/facts-hospice-and-palliative-care (Accessed on January 23, 2016).
- National Consensus Project for Quality Palliative Care. Clinical Practice Guidelines for Quality Palliative Care. National Quality Forum; New York, NY 2004.
- http://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm (Accessed on January 29, 2016).
- Dying in America Improving Quality and Honoring Individual Preferences Near the End of Life, Institute of Medicine, 2014.
- Saunders C. Introduction: history and challenge. In: The management of terminal malignant disease, Saunders C, Sykes N. (Eds), Hodder and Stoughton, London 1993. p.1.
- Higginson IJ, Edmonds P. Services, costs and appropriate outcomes in end of life care. Ann Oncol 1999; 10:135.
- Kissane DW. The relief of existential suffering. Arch Intern Med 2012; 172:1501.
- Teno JM, Connor SR. Referring a patient and family to high-quality palliative care at the close of life: "We met a new personality... with this level of compassion and empathy". JAMA 2009; 301:651.
- http://www.cgsmedicare.com/hhh/education/faqs/hospice_physician_billing_faqs.html (Accessed on February 26, 2016).
- Salpeter SR, Luo EJ, Malter DS, Stuart B. Systematic review of noncancer presentations with a median survival of 6 months or less. Am J Med 2012; 125:512.e1.
- Salpeter SR, Malter DS, Luo EJ, et al. Systematic review of cancer presentations with a median survival of six months or less. J Palliat Med 2012; 15:175.
- Fox E, Landrum-McNiff K, Zhong Z, et al. Evaluation of prognostic criteria for determining hospice eligibility in patients with advanced lung, heart, or liver disease. SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments. JAMA 1999; 282:1638.
- Carlson MD, Herrin J, Du Q, et al. Impact of hospice disenrollment on health care use and medicare expenditures for patients with cancer. J Clin Oncol 2010; 28:4371.
- Medicare program; FY 2014 hospice wage index and payment rate update; hospice quality reporting requirements; and updates on payment reform. Fed Regist 2013; 78:48234.
- Local Coverage Determination (LCD) for Hospice Determining Terminal Status, 2002-2011. Available at http://vergehomecare.com/yahoo_site_admin/assets/docs/lcd-LiverDisease.16795545.pdf.
- McCarthy EP, Burns RB, Ngo-Metzger Q, et al. Hospice use among Medicare managed care and fee-for-service patients dying with cancer. JAMA 2003; 289:2238.
- Kutner JS, Meyer SA, Beaty BL, et al. Outcomes and characteristics of patients discharged alive from hospice. J Am Geriatr Soc 2004; 52:1337.
- Teno JM, Plotzke M, Gozalo P, Mor V. A national study of live discharges from hospice. J Palliat Med 2014; 17:1121.
- Wright AA, Keating NL, Balboni TA, et al. Place of death: correlations with quality of life of patients with cancer and predictors of bereaved caregivers' mental health. J Clin Oncol 2010; 28:4457.
- Obermeyer Z, Makar M, Abujaber S, et al. Association between the Medicare hospice benefit and health care utilization and costs for patients with poor-prognosis cancer. JAMA 2014; 312:1888.
- Greer DS, Mor V, Morris JN, et al. An alternative in terminal care: results of the National Hospice Study. J Chronic Dis 1986; 39:9.
- Wallston KA, Burger C, Smith RA, Baugher RJ. Comparing the quality of death for hospice and non-hospice cancer patients. Med Care 1988; 26:177.
- Teno JM, Clarridge BR, Casey V, et al. Family perspectives on end-of-life care at the last place of care. JAMA 2004; 291:88.
- Connor SR, Pyenson B, Fitch K, et al. Comparing hospice and nonhospice patient survival among patients who die within a three-year window. J Pain Symptom Manage 2007; 33:238.
- Saito AM, Landrum MB, Neville BA, et al. Hospice care and survival among elderly patients with lung cancer. J Palliat Med 2011; 14:929.
- Brumley R, Enguidanos S, Jamison P, et al. Increased satisfaction with care and lower costs: results of a randomized trial of in-home palliative care. J Am Geriatr Soc 2007; 55:993.
- Gozalo P, Plotzke M, Mor V, et al. Changes in Medicare costs with the growth of hospice care in nursing homes. N Engl J Med 2015; 372:1823.
- http://www.nhpco.org/hospice-statistics-research-press-room/facts-hospice-and-palliative-care (Accessed on January 15, 2015).
- Shepperd S, Gonçalves-Bradley DC, Straus SE, Wee B. Hospital at home: home-based end-of-life care. Cochrane Database Syst Rev 2016; 2:CD009231.
- National Hospice and Palliative Care Organization Regulatory http://www.nhpco.org/regulatory.
- Stabenau HF, Morrison LJ, Gahbauer EA, et al. Functional trajectories in the year before hospice. Ann Fam Med 2015; 13:33.
- More beneficiaries use hospice; many factors contribute to shorter periods of use. HEHS-00-182; United States General Accounting Office, Washington, DC 2000.
- Han B, Remsburg RE, McAuley WJ, et al. National trends in adult hospice use: 1991-1992 to 1999-2000. Health Aff (Millwood) 2006; 25:792.
- Earle CC, Neville BA, Landrum MB, et al. Trends in the aggressiveness of cancer care near the end of life. J Clin Oncol 2004; 22:315.
- Christakis NA, Iwashyna TJ. Impact of individual and market factors on the timing of initiation of hospice terminal care. Med Care 2000; 38:528.
- Younis T, Milch R, Abul-Khoudoud N, et al. Length of survival in hospice for cancer patients referred from a comprehensive cancer center. Am J Hosp Palliat Care 2009; 26:281.
- Schockett ER, Teno JM, Miller SC, Stuart B. Late referral to hospice and bereaved family member perception of quality of end-of-life care. J Pain Symptom Manage 2005; 30:400.
- Kumar P, Wright AA, Hatfield LA, et al. Family Perspectives on Hospice Care Experiences of Patients with Cancer. J Clin Oncol 2017; 35:432.
- Casarett D, Van Ness PH, O'Leary JR, Fried TR. Are patient preferences for life-sustaining treatment really a barrier to hospice enrollment for older adults with serious illness? J Am Geriatr Soc 2006; 54:472.
- Casarett DJ, Quill TE. "I'm not ready for hospice": strategies for timely and effective hospice discussions. Ann Intern Med 2007; 146:443.
- THE HOSPICE MODEL OF CARE
- Distinction between hospice and palliative care
- The hospice interdisciplinary team
- Who is a candidate for hospice?
- - Common questions and misperceptions about hospice
- - Symptom control
- - Psychosocial and spiritual care
- - Nursing
- - Short-term intensified services
- - Bereavement care
- THE US MEDICARE HOSPICE BENEFIT
- BENEFITS AND LIMITATIONS OF HOSPICE
- DISCUSSING HOSPICE WITH PATIENTS AND FAMILIES
- INFORMATION FOR PATIENTS