Do Medicare HMOs and Medicare FFS Differ in Their Use of the Medicare Hospice Benefit?

Virnig, Beth A; Persily, Nancy Alfred; Morgan, Robert O.; DeVito, Carolee A.

doi:10.1080/0742-969x.1999.11882910

Cited by 31 publications

(34 citation statements)

References 6 publications

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“…In Taiwan, late referral for inpatient hospice care was reported to be 32.5% in 2004 (4), which is similar to the 30.8% reported in the US national statistics in 2007 (5), 29–36% reported by Virnig et al (6) and 35.1% reported by Farnon and Hofmann (7). …”

Section: Introductionsupporting

confidence: 70%

A Computer-assisted Model for Predicting Probability of Dying Within 7 Days of Hospice Admission in Patients with Terminal Cancer

Chiang

Cheng

Koo

et al. 2010

Japanese Journal of Clinical Oncology

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ObjectiveThe aim of the present study is to compare the accuracy in using laboratory data or clinical factors, or both, in predicting probability of dying within 7 days of hospice admission in terminal cancer patients.MethodsWe conducted a prospective cohort study of 727 patients with terminal cancer. Three models for predicting the probability of dying within 7 days of hospice admission were developed: (i) demographic data and laboratory data (Model 1); (ii) demographic data and clinical symptoms (Model 2); and (iii) combination of demographic data, laboratory data and clinical symptoms (Model 3). We compared the models by using the area under the receiver operator curve using stepwise multiple logistic regression.ResultsWe estimated the probability dying within 7 days of hospice admission using the logistic function, P = Exp(βx)/[1 + Exp(βx)]. The highest prediction accuracy was observed in Model 3 (82.3%), followed by Model 2 (77.8%) and Model 1 (75.5%). The log[probability of dying within 7 days/(1 − probability of dying within 7 days)] = −6.52 + 0.77 × (male = 1, female = 0) + 0.59 × (cancer, liver = 1, others = 0) + 0.82 × (ECOG score) + 0.59 × (jaundice, yes = 1, no = 0) + 0.54 × (Grade 3 edema = 1, others = 0) + 0.95 × (fever, yes = 1, no = 0) + 0.07 × (respiratory rate, as per minute) + 0.01 × (heart rate, as per minute) − 0.92 × (intervention tube = 1, no = 0) − 0.37 × (mean muscle power).ConclusionsWe proposed a computer-assisted estimated probability formula for predicting dying within 7 days of hospice admission in terminal cancer patients.

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Section: Introductionsupporting

confidence: 70%

A Computer-assisted Model for Predicting Probability of Dying Within 7 Days of Hospice Admission in Patients with Terminal Cancer

Chiang

Cheng

Koo

et al. 2010

Japanese Journal of Clinical Oncology

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“…Second, while race/ethnicity coding in the Medicare denominator file has a good positive predictive value for identifying Whites, Blacks and Hispanics (>94%), it performs less well for Asians and American Indian/Alaskan Native beneficiaries,39 making findings for the Other race/ethnicity category difficult to interpret. Finally, although higher hospice utilization has been reported among enrollees from health maintenance organizations compared to patients with traditional Medicare coverage,40 we could not include such patients in our study sample because of incomplete capture of diagnoses and health care utilization.…”

Section: Discussionmentioning

confidence: 99%

Racial and Ethnic Differences in Hospice Use Among Patients With Heart Failure

Givens¹

2010

Arch Intern Med

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Background Heart failure is the leading non-cancer hospice diagnosis and the leading cause of hospitalization among Medicare beneficiaries. Racial differences in hospice use are well documented for cancer but poorly described for heart failure. Methods Based on a national sample of 98,258 Medicare beneficiaries aged 66 and older on January 1, 2001 with a diagnosis of heart failure, who were not enrolled in hospice in 2000, we determined the effect of race/ethnicity on hospice entry for heart failure in 2001 after adjusting for sociodemographic, clinical, and geographic factors. Results In unadjusted analysis, Blacks (odds ratio [OR] = 0.52) and Hispanics (OR = 0.43) used hospice for heart failure less than Whites. Racial/ethic differences in hospice use for heart failure persisted after adjusting for markers of income, urbanicity, severity of illness, local density of hospice use, and medical comorbidity (adjusted odds ratio (AOR) for Blacks [AOR = 0.59 (95% confidence interval (CI), 0.47-0.73)], and for Hispanics [AOR = 0.49 (95% CI 0.37-0.66)], compared to Whites). Advanced age, greater comorbidity, emergency department visits, hospitalizations, and greater local density of hospice use were also associated with hospice utilization. Conclusions In a national sample of Medicare beneficiaries with heart failure, Blacks and Hispanics used hospice for heart failure less than Whites after adjustment for individual and market factors. This work extends the findings of racial and ethnic differences in hospice utilization to the leading non-cancer diagnosis. To understand the mechanisms underlying these findings, further examination of patient preferences and physician referral behavior are needed.

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“…The computerized database we had did not have information on a patient's type of Medicare program enrollment (i.e., fee-for-service or HMO) and, as found by Vernig and colleagues, 18 we may have found Medicare HMO enrollees to have had longer stays. While this omission does not affect the validity of our finding that significant increases in short hospice stays have occurred, it is possible that some of the differences found in lengths of stay across states may be attributable to the magnitude of HMO enrollment in these states.…”

Section: Limitationsmentioning

confidence: 96%

“…Diagnoses found to be associated with shorter hospice stays include renal failure, leukemia or lymphoma, and liver or biliary cancer 11 ; in nursing homes, compared to residents with cancer diagnoses, residents with dementia diagnoses and with diagnoses other than cancer or dementia were found to have a greater probability of a short stay (i.e., a stay of 1 week or less). 14 Other factors associated with shorter stays include male gender, 14,[16][17] white race, 11,17 private insurance status, 16 enrollment in Medicare's feefor-service program (versus a Medicare health management organization [HMO]), 18 living with a caregiver, 16 and having a hospital referral source. 16 Additionally, lengths of hospice stay have been found to vary by the site of hospice care provision (nursing home versus non-nursing home setting), 19 across states and health care markets, 17,20 and by hospice provider characteristics.…”

Section: Introductionmentioning

confidence: 99%

Factors Associated with the High Prevalence of Short Hospice Stays

Miller

Weitzen

Kinzbrunner³

2003

Journal of Palliative Medicine

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This study's goal was to gain an understanding of the factors associated with hospice stays of 7 days or less (i.e., short hospice stays), and to test the hypothesis that independent of changes in sociodemographics, diagnoses, and site-of-care, the likelihood of a short hospice stay increased over time. We examined hospice stays for 46655 nursing home and 80507 non-nursing home patients admitted between October 1994 and September 1999 to 21 hospices across 7 states, and owned by 1 provider. Logistic regression was used to determine the factors significantly associated with a higher probability of a short stay. Compared to patients admitted in (fiscal year) 1995, and controlling for potential confounders, the probability of a short stay significantly increased in each year after 1995 in nursing homes, and in 1999 in non-nursing home settings. In (fiscal year) 1995, a nursing home resident admitted to hospice had a 26% probability (95% confidence interval [CI] 0.24, 0.28) of a less than 8-day stay and, in (fiscal year) 1999, the probability was 33% (95% CI 0.31, 0.34); a non-nursing home patient had a 32% probability in 1995 (95% CI 0.30, 0.34) and a 36% probability in 1999 (95% CI 0.34, 0.37). The probability of a short hospice stay was greater for patients with noncancer diagnoses, independent of year of hospice admission. In this paper we discuss the possible underlying reasons for the increased probability of short hospice stays and we speculate on what this increase may mean in terms of hospice's ability to provide high-quality end-of-life care.

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Do Medicare HMOs and Medicare FFS Differ in Their Use of the Medicare Hospice Benefit?

Cited by 31 publications

References 6 publications

A Computer-assisted Model for Predicting Probability of Dying Within 7 Days of Hospice Admission in Patients with Terminal Cancer

A Computer-assisted Model for Predicting Probability of Dying Within 7 Days of Hospice Admission in Patients with Terminal Cancer

Racial and Ethnic Differences in Hospice Use Among Patients With Heart Failure

Factors Associated with the High Prevalence of Short Hospice Stays

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