Declining non-cancer admissions

Last month’s Hospice Management Advisor featured a cover story exploring questions about non-cancer admissions to hospice raised by former Washington, DC-based Hospice Association of America executive director Diane H. Jones, MSW, ACSW. Jones asked whether increased regulatory scrutiny in recent years has caused hospices to retreat from enrolling patients with diagnoses other than cancer. Although the issue remains vitally important to the hospice industry, subsequent information from the National Center for Health Statistics (NCHS) in Baltimore suggests that the statistical picture may be more complicated than HMA had portrayed.

NCHS tracks annual Medicare hospice admissions in two broad categories: based on current patients (i.e., on the rolls of the agency at midnight the day before the survey), and based on total discharges in a 12-month period. The two categories produce different results when it comes to non-cancer admissions, but the gap between the two has remained relatively stable from year to year. The data from NCHS show a big jump in non-cancer admissions from 1993 to 1994, and a slight drop-off from 1994 to 1996 for both statistical categories. (See chart, above.)

Other evidence comes from Stephen Connor, PhD, vice president for research and professional development at the National Hospice Organiza tion (NHO) in Arlington, VA. In NHO’s 1995 Hospice Census, 40% of U.S. hospice admissions were non-cancer. In a 1996 "PDQ Survey" by NHO, with a much smaller number of responding programs (169 vs. 1,000), the non-cancer share of patients had shrunk to 32%.

"This is precisely the time period when Operation Restore Trust was going on, and scrutiny on non-cancer patients was increasing," Connor observes. "We’ve heard a lot of mixed reports, but the general feeling is that local medical review policies are now having a chilling effect" on non-cancer admissions. However, only time and subsequent surveys will tell whether non-cancer enrollments will continue to go down, he says.


Percent of Hospice Admissions with Cancer or Non-cancer Diagnoses

 
1992
1993
1994
1996
Total current patients
52,100
50,100
61,000
59,400
Percentage with malignant neoplasms
65.7%
70.1%
56.9%
58.3%
Percentage of other (i.e., non-cancer)
34.3%
29.9%
43.1%
41.7%
Total discharges in 12-month period 
219,300 
257,2001
328,0001
393,2001
Percentage with malignant neoplasms
74.7%
78.1%
69.0%
69.7%
Percentage of other (i.e., non-cancer)
25.3%
21.9%
31.0%
30.3%

1. Covers the fiscal year Oct. 1 to Sept. 30.

Source: National Home and Hospice Care Surveys, National Center for Health Statistics, Baltimore.