The Hospice Algorithm: Capitalizing on Death and Dying

There is extensive literature on the significance of financial incentives in the Hospice Medicare Benefit (HMB) and the growth of proprietary ownership of hospices in the United States. A literature review indicates a paucity of information on hospice nurses’ perceptions of the impact of the HMB’s financial structure on care planning and delivery decisions. This article presents background on the topic and an initial, exploratory study to address the literature gap, based on interviews of a convenience sample of 48 hospice nurses from 6 different hospices between December 1, 2018, and January 31, 2020, in the New York City metropolitan area. Six themes emerged from the interviews: finances are the guiding principle in care planning and service delivery decisions; appropriate patient selection allows hospices to maximize profit by maximizing length of stay (LOS) and minimizing service utilization; balancing patient care needs, cost, and LOS is a challenge; live discharge decisions save money, but can compromise care; the Interdisciplinary Team (IDT) is where most major decisions are made regarding patient care and finances; and money drives patient care decisions, regardless of ownership type.