Slidedeck for Journal Club reviewing JAMA article from Feb 2, 2011: Association of Hospice Agency Profit Status With Patient Diagnosis, Location of Care, and Length of Stay

1. Christian Sinclair, MD, FAAHPM University of Kansas Medical Center Hospice and Palliative Medicine Fellowship Journal Club February 3rd, 2011 Free pdf avail Click me - (as of 2/3/11)

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4. Clinical Case Correlation Palliative Care Consult at a local hospital Hospice referral was appropriate Conversation with the case manager about different agencies Does profit status affect the care received?

5. Background For-profit hospice agencies growing Nearly half of all hospice agencies are FP 1660 FP agencies in 2007 For-profit hospice agencies have higher profit margins1 FP profit margin 12 to 16% NP profit margin -2.9 to -4.4% Medicare (CMS) is gathering data to revise the payment structure for hospice benefit Flat per-diem v. U-shaped curve Higher costs at beginning and end of care days 1 -MedPAC Report to Congress 2008, Chapter 8

6. Methods 2007 National Home and Hospice Care Survey 1545 agencies randomly selected 1036 participated Interviewed staff and reviewed med records 4705 patients discharged from hospice Due to death or live discharge

7. Race/Ethnicity (Table 1)

8. Diagnosis (Table 2)

9. Length of Stay Categories (Table 3)

11. Weak Points of Study Included only discharged patients Lacked agency specific data Lacked costs and revenues No correlation between data and quality of care

12. Conclusions Not sure this adds more than the MedPAC 2008 report Media coverage full of hyperbole

15. Conclusions for This Study Not sure this adds more than the MedPAC 2008 report Media coverage full of hyperbole Does this pit NP vs FP hospice agencies? Is this good for the field?

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