Although the hospice movement reached this country in the mid-1970s, only recently have many providers discovered the benefits of adding hospice care to their array of services.
As hospitals and other providers move closer to fully integrating medical services, they see hospice programs as playing a key role in the continuum of care.
Hospice administrators add that the hospice movement's philosophy meshes with providers' efforts to control skyrocketing medical costs.
Hospices provide medical and nursing services for terminally ill patients-those who have been diagnosed with less than six months to live. Services provided include medical and nursing care for patients, as well as support services and bereavement counseling for family members.
Programs are administered to patients in their homes, in hospitals, nursing homes and independent facilities.
Overall, the American Hospital Association listed approximately 1,100 hospitals, or 18% of all U.S. hospitals, as offering hospice services in 1994. That compares with an estimate by the National Hospice Organization that 521 of its 1,750 hospices are hospital-owned.
A 1994 study in the New England Journal of Medicine reported that reducing life-sustaining care for the terminally ill would cut healthcare costs by 3.3%, or $33 billion. Savings from reducing futile care and increasing the use of hospices and living wills would decrease overall healthcare costs, the report said.
More hospitals have considered adding hospices to their institutions since Congress approved Medicare reimbursement for hospice services in 1983. Hospice care typically costs an average of $85 to $100 per day-roughly 10% of the average inpatient hospitalization cost, experts say.
Hospitals that are adding hospices are doing so through a variety of business transactions, including joint ventures with independent providers, shared-service agreements with other hospitals and converting hospital units into hospice-based units.
For example, Covenant Healthcare System in Milwaukee last month formed an affiliation agreement with Milwaukee Hospice as part of the system's effort to integrate all of its healthcare services (March 6, p. 65).
Also, Vencor, a Louisville, Ky.-based operator of intensive-care hospitals, purchased Cincinnati-based Hospice Homecare in February for an undisclosed amount (Feb. 27, p. 41). Hospice Homecare provides hospice services to patients in 22 nursing homes, hospitals and residences in Cincinnati and Columbus, Ohio.
"Hospices are still a relatively young form of healthcare delivery," said Sharon Smith, executive director of Promina Kennestone Regional Hospice, a hospital-operated home hospice program owned by Kennestone Hospital, Marietta, Ga.
"As a concept, hospice care has grown due in part to the sheer number of patients (requesting hospice services)," Smith added.
Promina's program illustrates just how new hospices are to the healthcare industry. First established in 1983, it ranks as the oldest recognized hospice program in Georgia, Smith said. The hospice program-which administers medical and nursing care to patients at home-stemmed from the hospital's department of pastoral care.
The hospice will serve about 280 patients this year, she said. Promina budgets about $850,000 annually to staff and operate the hospice program. However, smaller hospital-based hospice programs can function on annual budgets of around $500,000, Smith said.
Promina's hospice program will be enhanced through the addition of the Visiting Nurses Health System, which in March agreed to affiliate with a 10-hospital alliance in Marietta, of which Kennestone Hospital is a part. The Visiting Nurses program provides home- and hospice-care services, and will complement Promina's hospice-care program, Smith added.
Although most hospital-operated hospice programs are administered at patients' homes, a growing contingent of hospitals is offering hospice care through inpatient hospice units.
"I've definitely seen an increase in (hospital-based) hospice programs," said Lilli Melchert, manager and business director of Desert Hospital Home Health and Hospice Services, Palm Springs, Calif.
Desert Hospital's hospice program, which also originated in 1983, is a 12-bed inpatient unit with an atmosphere that more closely resembles a home than a hospital. The unit allows 24-hour visitation, pets, children and anything else that would ease the concerns of the patient, Melchert said.
"Most hospice programs (in California) are affiliated with home-care companies," she said. "Few of the hospices are freestanding, while even fewer are linked with hospitals."
Although more expensive to operate than home-based hospice programs, hospital-based hospice units offer patients a sense of security, Melchert said. Patients know they have easy access to hospital services if they need acute medical care during their stay.
In addition, patients in hospital-based hospice units have more contact with their physicians, she said.
Among independent providers, hospice care is becoming big business. In fact, several prominent hospice providers are taking a page from their home-care counterparts and are growing through mergers and acquisitions.