As Hospital Compare has transitioned into Care Compare, more seniors, health plans, and risk-bearing entities are using this Medicare tool to review hospital quality outcomes and data points such as:
Readmissions;
30-day mortality rates;
Benchmarks against other hospitals, and;
quality of care provided
This information has never been more accessible to those who are planning for their own care or determining where their patients or attributed lives should go.
These rates can be frustrating for hospital providers. There are many different factors that might contribute to readmissions, mortality rates, and differences in quality scores.
Furthermore, the U.S. Department of Health and Human Services (HHS) notes that,
“Value Based Programs should account for differences in populations between providers and, in particular, whether programs should account for beneficiaries with social risk factors—people for whom factors such as income, housing, social support, transportation, and nutrition might adversely affect access to health services or desired health outcomes.” ¹
HHS acknowledges that social determinants of health should be factored into these results, though they currently aren’t. Patients who are dually eligible for Medicare and Medicaid, or those who suffer from food insecurity, lack an adequate social support system, or those who have multiple comorbidities are more likely to be readmitted or die within 30 days of a hospital stay. At first glance, these cases might be uncontrollable, even with the best of discharge plans.
While hospitals can’t see around every corner, prognostication is possible. In hospice, professionals often use this question as a quick gut check to determine how a patient is likely to fare:
“Would you be surprised if this patient died in the next six months?”
(final hospice eligibility is determined by two physicians certifying that a patient will die within six months if their disease runs its normal course).
Of course, no physician, nurse, or member of the hospital team can tell precisely when a patient may die. However, many clinicians have experience with patients who cycle through their hospital regularly when it’s clear the patient likely has only months or weeks to live.
Many of these readmissions could be the result of the underutilization of hospice services by Medicare beneficiaries:
Hospice is unique among Medicare benefits- an interdisciplinary team comes together to surround the patient and their family, offering comfort and support far beyond many other care models. Pain control, medication management, and durable medical equipment are all provided. Not only is physical comfort a core aim of hospice, but so are adequate psychosocial counseling, social service support, and even spiritual care. Families of patients also receive 12 months or more of bereavement care, even if their loved one was on service only for a few hours.
What does a timely referral to hospice achieve for a hospital or health system?
A thoughtful and strategic hospice partnership can help hospitals provide the care patients need while also helping with key metrics on Care Compare. Working to ensure that your hospice utilization strategy is intentional and effective is a critical component of health system management. No longer can hospice referrals be offered as an afterthought in the last days or even hours of a patient’s life, but they should rather be thought of as a core quality and management strategy for a forward-thinking hospital administration team.
¹ Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health & Human Services. Second Report to Congress on Social Risk Factors and Performance in Medicare’s Value-Based Purchasing Program. 2020. https://aspe.hhs.gov/social-risk-factors-and-medicares-value-basedpurchasing-programs
² NHPCO Facts and Figures 2020