Hospice care reduces readmissions

by Dr. Robert Smith, HPCCR Medical Director

In 2008, Medicare costs reached almost $600 billion.  As the percentage of the US population over the age of 65 increases, these costs are only going to continue to rise.  And because much of the cost in caring for a patient is spent in the last months of life, an approach to caring for patients with terminal illnesses that is rational (not to be confused with rationed) and focused on quality of care rather than quantity of care will ultimately reduce health care costs.  Hospice care remains the gold standard for cost-effective, high quality care of patients with terminal illnesses.

The current health care reform plan is committed to reducing costs.  In April 2009, the Medicare Payment Advisory Commission (MedPAC) recommended that payments to hospitals with high readmissions should be reduced.  Accordingly, President Obama’s 2010 budget includes provisions that will not only consolidate payments for hospitalization and post-acute care into one payment, but will also pay less to hospitals that have high rates of patients readmitted within 30 days of discharge.1  For hospitals with high readmission rates, this could mean a significant loss of revenue.

Increased utilization of hospice services can help hospitals and physicians with the challenge of reducing readmissions.  When physicians have those difficult conversations with a patient whose illness is no longer responding to aggressive, disease-specific treatment and a referral for hospice care is made, the patient is less likely to opt for expensive (and often traumatic) treatments and will make fewer costly trips to the emergency room.  And what’s more, these patients will die with peace and dignity, most likely at home with family, rather than in an impersonal hospital room.  While the focus of health care reform may be on cost-cutting alone, we believe that the potential secondary benefit of increased referral to (and awareness of) hospice care will benefit all Americans as well.


1 Jweinat, Jillian J. Hospital readmissions under the spotlight. Journal of Healthcare Management. 55 (July/August 2010): 252-264.

Explore posts in the same categories: education, health care reform, hospice, Medicare, palliative

2 Comments on “Hospice care reduces readmissions”

  1. Thank you Dr. Smith for this posting. I live with the guilt of all the cost to Medicare that my mother received when she was terminal and my family would not consent to hospice care, but rather wanted everthing that could possibly be done to keep her alive. In the end the costs were staggering. She had no listed Health Care Power of Attorney nor a Living Will. Not only were the agressive treatments not what she wanted, but my family just could not agree to let her have Comfort Care through Hospice. They felt like it was a sign of giving up. More education is needed to families everywhere.

  2. hpccr Says:

    Thanks, Anngie, for your comment. Your story illustrates this issue perfectly!

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