Organizational and environmental correlates of the adoption of a focus strategy in U.S. hospices

Abstract

Hospices may be adopting a nursing facility focus strategy in response to increasing competition. The decision to focus the provision of care to nursing facility residents may be driven by the need to secure stability in referrals. Further empirical exploration of the performance implications of adopting a nursing facility focus strategy is warranted.

Factors associated with the provision of inpatient care in hospices

“…This study adds to the growing body of hospice literature by using RDT to examine market factors on hospice inpatient services offering. Similar to other studies that adopted RDT as conceptual framework (Apenteng et al, 2015; Lindley et al, 2013), this study found partial support of RDT in hospice literature. As the U.S. OIG suggested: “CMS should focus on hospices that do not provide inpatient care and ensure that these hospices are providing beneficiaries access to needed levels of care at the end of their lives” (OIG, 2013); we found that only a small number of hospices did not offer any inpatient care at all, and the rest of hospices offer inpatient care directly by staff, under arrangement, or combined.…”

“…According to RDT, all main independent variables are categorized as market munificence, dynamism, and complexity. Based on the existing literature, munificence was operationalized using urban location (Menachemi et al, 2011; Zinn et al, 1996), per capita income (Apenteng et al, 2015; Hsieh et al, 2010; Kazley & Ozcan, 2007; Menachemi et al, 2011; Zinn et al, 1996), and the percentage of population aged 65 years and older (Menachemi et al, 2011). Per capita income was log-transformed because it was not normally distributed.…”

Factors associated with the provision of inpatient care in hospices

“…This study adds to the growing body of hospice literature by using RDT to examine market factors on hospice inpatient services offering. Similar to other studies that adopted RDT as conceptual framework (Apenteng et al, 2015; Lindley et al, 2013), this study found partial support of RDT in hospice literature. As the U.S. OIG suggested: “CMS should focus on hospices that do not provide inpatient care and ensure that these hospices are providing beneficiaries access to needed levels of care at the end of their lives” (OIG, 2013); we found that only a small number of hospices did not offer any inpatient care at all, and the rest of hospices offer inpatient care directly by staff, under arrangement, or combined.…”

“…According to RDT, all main independent variables are categorized as market munificence, dynamism, and complexity. Based on the existing literature, munificence was operationalized using urban location (Menachemi et al, 2011; Zinn et al, 1996), per capita income (Apenteng et al, 2015; Hsieh et al, 2010; Kazley & Ozcan, 2007; Menachemi et al, 2011; Zinn et al, 1996), and the percentage of population aged 65 years and older (Menachemi et al, 2011). Per capita income was log-transformed because it was not normally distributed.…”

Hospice inpatient services provision, utilization, and financial performance

“…We found the average per capita income of counties where hospices are located to be negatively associated with LOS and financial performance. Apenteng et al (2015) found that hospices located in wealthier markets were more likely to adopt a nursing facility focus strategy. The possible explanation was that people from wealthier counties would like to consider other hospice-embedded options (e.g., nursing home with hospices, hospitals with hospice program) than freestanding hospices.…”

“…In addition, we found that market competition was associated with longer LOS, and competition from hospitals with hospice programs was positively associated with higher ROA for freestanding hospices. When facing competition from other hospice agencies, hospices may choose certain strategies (e.g., volunteer use) to make sure patients stay longer in the hospice and generate more revenue from the longer stay (Apenteng et al, 2015; Huskamp et al, 2001; MedPAC, 2015). Compared to rural hospices, urban hospices had longer LOS but poor financial performance, which is inconsistent with previous findings where no significant difference of financial performance was observed between urban and rural hospices in California (O'Neill et al, 2009).…”

“…Variables were identified from the hospice performance literature as factors that may influence hospice financial performance (Apenteng et al, 2015; Kirby, 2012; Kirby et al, 2007). Accordingly, control variables contain both environmental and organizational factors.…”

Factors associated with the provision of inpatient care in hospices

“…This study adds to the growing body of hospice literature by using RDT to examine market factors on hospice inpatient services offering. Similar to other studies that adopted RDT as conceptual framework (Apenteng et al, 2015; Lindley et al, 2013), this study found partial support of RDT in hospice literature. As the U.S. OIG suggested: “CMS should focus on hospices that do not provide inpatient care and ensure that these hospices are providing beneficiaries access to needed levels of care at the end of their lives” (OIG, 2013); we found that only a small number of hospices did not offer any inpatient care at all, and the rest of hospices offer inpatient care directly by staff, under arrangement, or combined.…”

“…According to RDT, all main independent variables are categorized as market munificence, dynamism, and complexity. Based on the existing literature, munificence was operationalized using urban location (Menachemi et al, 2011; Zinn et al, 1996), per capita income (Apenteng et al, 2015; Hsieh et al, 2010; Kazley & Ozcan, 2007; Menachemi et al, 2011; Zinn et al, 1996), and the percentage of population aged 65 years and older (Menachemi et al, 2011). Per capita income was log-transformed because it was not normally distributed.…”

Hospice inpatient services provision, utilization, and financial performance

“…We found the average per capita income of counties where hospices are located to be negatively associated with LOS and financial performance. Apenteng et al (2015) found that hospices located in wealthier markets were more likely to adopt a nursing facility focus strategy. The possible explanation was that people from wealthier counties would like to consider other hospice-embedded options (e.g., nursing home with hospices, hospitals with hospice program) than freestanding hospices.…”

“…In addition, we found that market competition was associated with longer LOS, and competition from hospitals with hospice programs was positively associated with higher ROA for freestanding hospices. When facing competition from other hospice agencies, hospices may choose certain strategies (e.g., volunteer use) to make sure patients stay longer in the hospice and generate more revenue from the longer stay (Apenteng et al, 2015; Huskamp et al, 2001; MedPAC, 2015). Compared to rural hospices, urban hospices had longer LOS but poor financial performance, which is inconsistent with previous findings where no significant difference of financial performance was observed between urban and rural hospices in California (O'Neill et al, 2009).…”

“…Variables were identified from the hospice performance literature as factors that may influence hospice financial performance (Apenteng et al, 2015; Kirby, 2012; Kirby et al, 2007). Accordingly, control variables contain both environmental and organizational factors.…”

Factors associated with the provision of inpatient care in hospices

“…This study adds to the growing body of hospice literature by using RDT to examine market factors on hospice inpatient services offering. Similar to other studies that adopted RDT as conceptual framework (Apenteng et al, 2015; Lindley et al, 2013), this study found partial support of RDT in hospice literature. As the U.S. OIG suggested: “CMS should focus on hospices that do not provide inpatient care and ensure that these hospices are providing beneficiaries access to needed levels of care at the end of their lives” (OIG, 2013); we found that only a small number of hospices did not offer any inpatient care at all, and the rest of hospices offer inpatient care directly by staff, under arrangement, or combined.…”

“…According to RDT, all main independent variables are categorized as market munificence, dynamism, and complexity. Based on the existing literature, munificence was operationalized using urban location (Menachemi et al, 2011; Zinn et al, 1996), per capita income (Apenteng et al, 2015; Hsieh et al, 2010; Kazley & Ozcan, 2007; Menachemi et al, 2011; Zinn et al, 1996), and the percentage of population aged 65 years and older (Menachemi et al, 2011). Per capita income was log-transformed because it was not normally distributed.…”

Hospice inpatient services provision, utilization, and financial performance

“…We found the average per capita income of counties where hospices are located to be negatively associated with LOS and financial performance. Apenteng et al (2015) found that hospices located in wealthier markets were more likely to adopt a nursing facility focus strategy. The possible explanation was that people from wealthier counties would like to consider other hospice-embedded options (e.g., nursing home with hospices, hospitals with hospice program) than freestanding hospices.…”

“…In addition, we found that market competition was associated with longer LOS, and competition from hospitals with hospice programs was positively associated with higher ROA for freestanding hospices. When facing competition from other hospice agencies, hospices may choose certain strategies (e.g., volunteer use) to make sure patients stay longer in the hospice and generate more revenue from the longer stay (Apenteng et al, 2015; Huskamp et al, 2001; MedPAC, 2015). Compared to rural hospices, urban hospices had longer LOS but poor financial performance, which is inconsistent with previous findings where no significant difference of financial performance was observed between urban and rural hospices in California (O'Neill et al, 2009).…”

“…Variables were identified from the hospice performance literature as factors that may influence hospice financial performance (Apenteng et al, 2015; Kirby, 2012; Kirby et al, 2007). Accordingly, control variables contain both environmental and organizational factors.…”