title: Hospices' enrollment policies may contribute to underuse of hospice care in the United States.
abstract: Hospice use in the United States is growing, but little is known about barriers that terminally ill patients may face when trying to access hospice care. This article reports the results of the first national survey of the enrollment policies of 591 US hospices. The survey revealed that 78 percent of hospices had at least one enrollment policy that may restrict access to care for patients with potentially high-cost medical care needs, such as chemotherapy or total parenteral nutrition. Smaller hospices, for-profit hospices, and hospices in certain regions of the country consistently reported more limited enrollment policies. We observe that hospice providers' own enrollment decisions may be an important contributor to previously observed underuse of hospice by patients and families. Policy changes that should be considered include increasing the Medicare hospice per diem rate for patients with complex needs, which could enable more hospices to expand enrollment.
authors.affiliation: Mount Sinai School of Medicine, in New York City, NY, USA. melissa.carlson@mssm.edu
authors.forename: Melissa D
authors.initials: MD
authors.lastname: Aldridge Carlson
authors.forename: Colleen L
authors.initials: CL
authors.lastname: Barry
authors.forename: Emily J
authors.initials: EJ
authors.lastname: Cherlin
authors.forename: Ruth
authors.initials: R
authors.lastname: McCorkle
authors.forename: Elizabeth H
authors.initials: EH
authors.lastname: Bradley
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D003430:Cross-Sectional Studies; D005260:Female; D006291:Health Policy / Q000331:legislation & jurisprudence; D006297:Health Services Accessibility / Q000331:legislation & jurisprudence*; D017051:Hospice Care / Q000191:economics / Q000706:statistics & numerical data*; D006738:Hospices / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D006278:Medicare / Q000191:economics; D020380:Needs Assessment; D010166:Palliative Care / Q000191:economics / Q000706:statistics & numerical data*; D018579:Patient Selection; D011050:Policy Making; D012044:Regression Analysis; D014481:United States