Managing Competency in Hospice Live Discharges

hospice discharge

New research shows, in the Unites States hospices, one in every three patients are dropping the service before dying— a clear sign of trouble in an industry supposed to care for patients until death. When that many patients leave a hospice alive means either the agencies are driving them away with poor care, or they are enrolling patients who aren’t really dying in order to pad their profits. For hospices, it’s normal to release a small portion of patient alive because of improved health. However, researchers have found that at some hospices the rate of patients leaving hospice care alive has more than doubled.

Joan Teno, the lead author of the article published in the Journal of Palliative Medicine and a hospice doctor said “When you have a live discharge rate that is as high as 30 percent, you have to wonder whether a hospice program is living up to the vision and morality of the founders of hospice. One part of the reason is some of the new hospice providers may not have the same values — they may be more concerned with profit margins than compassionate care.”

In 2010, more than 12,000 patients were released alive from hospices, and they had to be readmitted in the hospital within two days, and eventually had to be re-enrolled in hospice again. This alarming practice can be disruptive for the dying and the terminally ill.

Hospice-driven Discharges

According to the Medicare Hospice Conditions of Participation (Hospice CoPs), a hospice provider may discharge a patient for the following three reasons:

  • The patient is relocating out of the hospice’s service area or transfers to another


  • The hospice provider determines that the patient is no longer terminally ill; and
  • The hospice provider determines that the behavior of the patient is disruptive, abusive, or uncooperative so much so that delivery of care or ability to operate effectively is seriously impaired.

 Program for Evaluating Payment Patterns Electronic Report (PEPPER)

As the Medicare watchdogs are putting more focus on hospices, a CMS compliance monitoring tool for hospitals and other providers called Program for Evaluating Payment Patterns Electronic Report (PEPPER) data is like a blessing in disguise, as it is suppose to shed more light on the potential risk areas in hospices. The PEPPERs are free reports on billing rates in certain risk areas, and they are designed to help hospitals and other providers modify their compliance monitoring to outliers unique to their facilities. For each provider type, PEPPERs have different risk areas, and in the case of hospices there are two risk areas: Live discharge rate for beneficiaries with a length of stay less than 25 days, and beneficiaries who receive hospice services for greater than 180 days. They are mainly developed as an educational tool for the provider.

The regulatory requirements and the implications of live discharges under the Medicare Hospice Benefit can be confusing. Expert speaker Charlene Ross, MSN, MBA, RN talks about the regulatory requirements for hospice discharges and beneficiary revocations in this audio session. As CMS continues to look at live discharges and gather data surrounding them, this session will help you improve your hospice’s regulatory competency related to live discharges.

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