LOS is not just a U.S. problem
Short length of stay in hospice care continues to bedevil the industry, with serious repercussions for both hospices' bottom lines and patients' quality of life. Many in hospice suggest that primary drivers for this trend are increased regulatory scrutiny and design flaws in the Medicare hospice benefit. However, the problem may reflect broader cultural issues and worldwide advances in medical technology, suggests Vincent Mor, PhD, director of the Center for Gerontology and Health Care Research at Brown University in Providence, RI. (For further discussion of regulatory impact on hospice, see cover story.)
Mor has made an informal comparison of hospice length-of-stay data in a number of developed countries, including the United Kingdom, Australia, New Zealand, Italy, and Israel. "The length-of-stay distribution in these countries, while not exactly identical, looks pretty much like ours," he concludes. A relatively high proportion of patients, 25% to 40%, enter hospice relatively shortly before they die, in the final 10 to 20 days of life. "That suggests that the short length of stay is not merely a phenomenon of our reimbursement system. I would call it more of a biological phenomenon," says Mor.
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