An Examination of the Effect of Reimbursement and Organizational Structure on the Allocation of Hospice Staff Time

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Abstract
The unique needs of the terminally ill patient may require more planning and service coordination than those of the nonterminal patient. The hospice interdisciplinary team was a response to these additional needs. This paper examines the pattern of patient care and administrative activities of paid hospice staff by hospice organizational type and demonstration status in the National Hospice Study. Data gathered over a one year period revealed that demonstration hospices, in which all allowable costs were Medicare reimbursed, spent significantly more time in general and patient related administrative activities than nondemonstration hospices, which operated within existing Medicare cost limits. Staff in demonstration home care-based hospices reported significantly longer home visits than staff in non-demonstration hospices. In both groups, home carebased hospice visits were of longer duration than those home visits conducted by staff of hospital-based hospices.

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