title: Paying the price at the end of life: a consideration of factors that affect the profitability of hospice.
abstract: OBJECTIVE
  To evaluate factors that affect the financial performance of hospice.
  
  
  METHODS
  Using the California Office of Statewide Health Planning and Development 2003 survey, we evaluated the organizational attributes, clinical care, and financial performance of 185 operational hospices. As outcomes, we evaluated revenues, costs, and profits per patient and per patient-day, the intensity and skill mix of care, and the provision of charitable and special palliative services. We evaluated regression-adjusted differences by profit status controlling for other organizational features and aggregate patient characteristics.
  
  
  RESULTS
  Hospices reported median revenue of $6865 per patient and $138 per patient-day (for-profit-not-for profit [FP-NFP] difference -$20, p = 0.045), median cost of $6737 per patient, and $135 per patient-day (FP-NFP difference -$55, p = 0.002), and median pretax profit of $334 per patient and $6 per patient-day (FP-NFP difference $34, p = 0.026). Patients received a median of 29.9 total visits by all providers per patient (FP-NFP difference 8.8 visits, p = 0.010), but there was no difference in total visits per patient-day. A median of 50.8% of all nursing visits were registered nurse (RN) visits (FP-NFP difference -14.1%, p < 0.001). Few hospices provided charity care, and only 4% of hospices reported expenditures on chemotherapy and only 9% on radiation therapy.
  
  
  CONCLUSIONS
  Overall hospice profitability is low. Length of stay is strongly associated with financial performance, and greater FP profitability is related to lower costs. FP hospices also provide less RN care as a proportion of nursing care. Few hospices provide charitable care or special costly services. The relationship of service patterns to patient quality needs to be examined.
authors.affiliation: Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA. soneill@prgs.edu
authors.forename: Sean M
authors.initials: SM
authors.lastname: O'Neill
authors.forename: Susan L
authors.initials: SL
authors.lastname: Ettner
authors.forename: Karl A
authors.initials: KA
authors.lastname: Lorenz
mesh_terms: D002140:California; D004358:Drug Therapy; D017598:Efficiency, Organizational / Q000191:economics; D005375:Financial Audit; D019538:Health Care Surveys; D006738:Hospices / Q000191:economics*; D006801:Humans; D010166:Palliative Care; D011878:Radiotherapy; D013727:Terminal Care / Q000191:economics*; D017664:Uncompensated Care
references.citation: Ann Intern Med. 2008 Jan 15;148(2):147-59
references.pmid: 18195339
references.citation: J Palliat Med. 2002 Aug;5(4):507-14
references.pmid: 12243675
references.citation: Hosp Community Psychiatry. 1984 Oct;35(10):1009-13
references.pmid: 6386650
references.citation: J Am Geriatr Soc. 2004 May;52(5):725-30
references.pmid: 15086652
references.citation: JAMA. 2000 Nov 15;284(19):2489-94
references.pmid: 11074779
references.citation: NIH Consens State Sci Statements. 2004 Dec 6-8;21(3):1-26
references.pmid: 17308546
references.citation: JAMA. 2005 Jul 13;294(2):211-7
references.pmid: 16014595
references.citation: JAMA. 1999 Nov 3;282(17):1638-45
references.pmid: 10553790
references.citation: J Palliat Med. 2003 Aug;6(4):585-91
references.pmid: 14516500
references.citation: N Engl J Med. 1996 Apr 18;334(16):1057-9
references.pmid: 8598847
references.citation: Am J Med. 2001 Jul;111(1):38-44
references.pmid: 11448659
references.citation: N Engl J Med. 1996 Apr 18;334(16):1055-7
references.pmid: 8598846
references.citation: Health Aff (Millwood). 2001 May-Jun;20(3):204-11
references.pmid: 11585168
references.citation: Health Aff (Millwood). 2001 Jul-Aug;20(4):188-95
references.pmid: 11463076
references.citation: JAMA. 2004 Jan 7;291(1):88-93
references.pmid: 14709580
references.citation: JAMA. 2000 Nov 15;284(19):2476-82
references.pmid: 11074777
references.citation: Hosp Community Psychiatry. 1984 Oct;35(10):1013-6
references.pmid: 6489947
references.citation: Med Care. 2004 Sep;42(9):871-4
references.pmid: 15319612