Hospice Disenrollment Among Patients With Dementia Varies by Patient Characteristics, Geography

Researchers examined a nationally representative study of hospice enrollees with dementia and determined hospice disenrollment varied by geographic location, type of hospice, and patient characteristics such as sex, age, race, and ethnicity.

A lack of information about patterns of disenrollment among the growing number of hospice enrollees with dementia led study authors to conduct a retrospective, observational cohort study of 100% Medicare beneficiaries with dementia aged 65 years and older enrolled in Medicare Hospice Benefit between July 2012 and December 2017.

The study initially included 867,695 hospice enrollees with dementia, but 70,945 (8.2%) were disenrolled due to extended prognosis and 43,133 (5.0%) revoked within 1-year of index admission.

“There was substantial variation in hospice provider disenrollment due to extended prognosis (10th-90th percentile 4.5%-14.6%, adjusted median odds ratio (MOR) 1.86, 95% confidence interval (CI) 1.82, 1.91) and revocation (10th-90th percentile 2.5%-10.1%, MOR 2.09, 95% CI 2.03, 2.14),” wrote researchers.

More variation in revocation (10th-90th percentile 3.5%-7.6%, MOR 1.4, 95% CI 1.34, 1.47) than extended prognosis (10th-90th percentile 7.0%-9.5%, MOR 1.23, 95% CI 1.18, 1.27) was reported among hospital referral regions.

Hospital referral regions located in the southeast and southern California experienced much higher revocation rates.

Some patient and hospice characteristics were connected to revocation only (more comorbidities, newer, smaller, and for profit-hospices), but a number were linked to higher odds of both types of disenrollment (younger age, female sex, minoritized race and ethnicity, Medicaid dual eligibility, Medicare Part C enrollment).

“These findings raise important questions about whether and how the Medicare Hospice Benefit could be adapted to reduce disparities and better support people living with dementia,” concluded study authors.

Reference:
Hunt LJ, Gan S, Boscardin J, et al. A national study of disenrollment from hospice among people with dementia. J Am Geriatr Soc. Published online June 7, 2022. doi:10.1111/jgs.17912