The Case for Timely Referral to Hospice: Improved Patient & Family Satisfaction With Care and Healthcare Spend

Timely referrals to hospice leave families more satisfied with their loved one's care while also decreasing unnecessary hospitalizations and lowering healthcare spend, recent studies show.

Still, Trella Health reported that only about 7% of hospice-eligible patients received an early referral to hospice. When contrasted with the Kaiser Family Foundation’s findings that 85% of Americans who have heard of hospice hold a positive opinion about it, clinicians and healthcare professionals are left to reconcile a considerable gap between the kind of care patients want and the care they’re actually receiving.

It’s a gap that can be closed when healthcare professionals make timely referrals to hospice for patients whose life expectancy is 6 months or less.

Higher Satisfaction when Hospice Patients are Referred Sooner

The core services of hospice are robust yet surprisingly simple to understand: An interdisciplinary team of clinical experts supports a patient’s and family’s personal goals for care near the end of life, ensuring their physical, psychosocial, and spiritual needs are met.

Likewise, it’s easy to grasp how this model benefits patients and families seeking help through one of life’s most challenging periods. The benefits of hospice have been studied and quantified for decades.

A 2017 report in the Journal of Clinical Oncology demonstrated that family members of patients receiving hospice care were more likely to express satisfaction with their loved ones’ symptom relief than relatives of nonhospice patients.

The report also found that earlier hospice referrals correlated with higher approval ratings from patients’ families.

Earlier Referrals to Hospice = Lower Healthcare Spend

These benefits extend to clinicians and other healthcare professionals. Data from a 2020 Trella Health study show how hospice patients—especially those referred to hospice early—face significantly fewer unnecessary hospitalizations and reduced healthcare spend compared to patients who did not receive hospice.

Related: Strong Hospice Presence in Nursing Homes Reduces Risk of End-of-Life Hospitalization >

An analysis of 904,000 patients who died between July 2018 and 2019 demonstrated that nonhospice patients accumulated six times the healthcare costs of patients in the early hospice admission cohort ($28,119 vs. $4,913).

Researchers examined costs across care settings, inpatient and ER utilization, and related metrics based on ICD-10-CM chapters. Patients were required to have at least one hospitalization in the year before their death. These patients were grouped into four cohorts based on their amount of time receiving hospice care:

• Early hospice admission (≥3 months of care)
• Medium hospice admission (2 weeks–3 months of care)
• Late hospice admission (<2 weeks of care)
• No hospice care

Key Findings

• Patients who received early hospice care were 10 times less likely to be admitted to the hospital during their final month of life than their nonhospice peers.
• When examining all terminal conditions, nonhospice patients took on an average of $27,455 more in healthcare costs than early hospice patients in the last three months of life.
• Emergency room visits were 5 times more likely for late hospice patients than early hospice patients in the last month of life.

Hospice Patients Receive Care Where They Want It

The last point reflects a key point from the 2017 Journal of Clinical Oncology study: About 68% of hospice enrollees died in their preferred setting, compared to 39% of nonhospice patients.

A 2017 Kaiser Family Foundation study found that about 70% of Americans would prefer to pass away at home.

VITAS can provide high-acuity care and complex modalities to treat nearly any symptom in any setting, ensuring patients remain comfortable in a familiar place, surrounded by family who feel at peace with the care their loved one is receiving.

Physicians, nurse practitioners, and other healthcare professionals who care for patients with advanced illness can close this gap by referring to hospice as soon as they are eligible. VITAS makes it easy.

For starters, you can share the findings of the aforementioned studies with patients and families who may be unfamiliar with hospice and its benefits.

If you’re unsure whether a patient is ready for hospice, download a PDF of our disease-specific hospice eligibility guidelines.

Finally, when you’re ready to refer, VITAS is always available—24/7/365. Our compassionate, committed clinical experts are standing by to accept referrals, perform eligibility assessments, and transition patients to comfort-focused hospice care at any hour, including weekends and holidays.