Closing the Gap in Hospice Utilization for the Minority Medicare Population

Abstract

Background: Medicare spends about 20% more on the last year of life for Black and Hispanic people than White people. With lower hospice utilization rates, racial/ethnic minorities receive fewer hospice-related benefits such as lesser symptoms, lower costs, and improved quality of life. For-profit hospices have higher dropout rates than nonprofit hospices, yet target racial/ethnic minority communities more through community outreach. This analysis examined the relationship between hospice utilization and for-profit hospice status and conducted an economic analysis of racial/ethnic minority utilization. Method: Cross-sectional analysis of 2014 Centers for Medicare & Medicaid Services (CMS), U.S. Census, and Hospice Analytics data. Measures included Medicare racial/ethnic minority hospice utilization, for-profit hospice status, estimated cost savings, and several demographic and socioeconomic variables. Results: The prevalence of for-profit hospices was associated with significantly increased hospice utilization among racial/ethnic minorities. With savings of about $2,105 per Medicare hospice enrollee, closing the gap between the White and racial/ethnic minority populations would result in nearly $270 million in annual cost savings. Discussion: Significant disparities in hospice use related to hospice for-profit status exist among the racial/ethnic minority Medicare population. CMS and state policymakers should consider lower racial/ethnic minority hospice utilization and foster better community outreach at all hospices to decrease patient costs and improve quality of life.

Goals-of-Care Consultation Associated With Increased Hospice Enrollment Among Propensity-Matched Cohorts of Seriously Ill African American and White Patients

“…In addition to evidence of hospice patients living longer than similarly ill patients who do not receive hospice (39,40), hospice has been found to be associated with patients having fewer unmet needs, higher quality of care, better quality of dying, improved emotional support for patient or family, and better overall satisfaction among families (3,(41)(42)(43). Hospice also benefits health systems and payers by reducing unnecessary acute care use and related costs (2,44). Palliative care consultations to discuss goals-of-care are similarly associated with cost reductions (2,19,45), likely partly due in part to increased use of hospice.…”

Women’s Experiences of Managing Work and End-of-Life Care: Challenges, Rewards and Recommendations for Vocational Psychologists

“…In addition, racial and ethnic minority individuals are less likely to be involved in end-of-life planning and more likely to die in hospitals as opposed to at home (Orlovic et al, 2019). Furthermore, ethnic minority individuals with low incomes reported using hospice care services less (Hughes & Vernon, 2019), which might result in additional physical, psychological, and financial burdens to the caregivers (Born et al, 2004).…”

The Forgotten and Misdiagnosed Care Transition: Live Discharge From Hospice Care

“…Historically marginalized racial/ethnic populations in the United Sates are less likely to enroll onto hospice services ( Hughes & Vernon, 2019 ), yet when they do enroll, they are more likely to be discharged alive ( Russell et al, 2017 ). Commonly reported challenges to hospice care which may contribute to disparities in live discharges for racial/ethnic individuals include cultural incongruities, less knowledge about hospice services, and lower completion and/or discussion of directives and end-of-life wishes ( Russell et al, 2020 ).…”