Physician Characteristics Strongly Predict Patient Enrollment In Hospice

THIS IS A POWERFULL STATEMENT ON WHO REFERS PATIENTS TO HOSPICE MOST COMMONLY  AND THE COSTS ASSOCIATED WITH NOT DOING SO, INCLUDING NON FINANCIAL COSTS. ONCOLOGISTS MOST COMMONLY MAKE THE REFERRAL

Physician Characteristics Strongly Predict Patient Enrollment In Hospice

  1. Ziad Obermeyer 1 , *,
  2. Brian W. Powers 2,
  3. Maggie Makar 3,
  4. Nancy L. Keating 4 and
  5. David M. Cutler 5

1Ziad Obermeyer (zobermeyer@partners.org) is an assistant professor of emergency medicine and health care policy at Harvard Medical School and an emergency physician at Brigham and Women’s Hospital, in Boston, Massachusetts.

  1. 2Brian W. Powers is an MD candidate at Harvard Medical School.
  2. 3Maggie Makar is a research assistant in the Department of Emergency Medicine at Brigham and Women’s Hospital.

  3. 4Nancy L. Keating is a professor of health care policy and medicine at Harvard Medical School and an internist at Brigham and Women’s Hospital.
    5David M. Cutler is the Otto Eckstein Professor of Applied Economics at Harvard University and a research associate at the National Bureau of Economic Research, both in Cambridge, Massachusetts.
  1. *Corresponding author

Abstract

Individual physicians are widely believed to play a large role in patients’ decisions about end-of-life care, but little empirical evidence supports this view. We developed a novel method for measuring the relationship between physician characteristics and hospice enrollment, in a nationally representative sample of Medicare patients. We focused on patients who died with a diagnosis of poor-prognosis cancer in the period 2006–11, for whom palliative treatment and hospice would be considered the standard of care. We found that the proportion of a physician’s patients who were enrolled in hospice was a strong predictor of whether or not that physician’s other patients would enroll in hospice. The magnitude of this association was larger than that of other known predictors of hospice enrollment that we examined, including patients’ medical comorbidity, age, race, and sex. Patients cared for by medical oncologists and those cared for in not-for-profit hospitals were significantly more likely than other patients to enroll in hospice. These findings suggest that physician characteristics are among the strongest predictors of whether a patient receives hospice care—which mounting evidence indicates can improve care quality and reduce costs. Interventions geared toward physicians, both by specialty and by previous history of patients’ hospice enrollment, may help optimize appropriate hospice use.

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