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Hospice Enrollment

By Lisa Schulmeister, RN, MN, APRN-BC, OCN®, FAAN
A study conducted by a group of researchers in Boston examined factors that predict patient enrollment in hospice care, and they included demographic and healthcare system factors. The study group consisted of a nationally representative sample of 198,948 Medicare fee-for-service beneficiaries in the United States who died from 2006 to 2011 following a cancer diagnosis with a poor prognosis. Two thirds of the patients (n = 131,757; 66%) enrolled in hospice. The researchers also identified 70,073 physicians who cared for patients with poor-prognosis cancers and found that the top 10% of these physicians cared for nearly half (47%) of all patients included in the study. Although medical and radiation oncologists comprised 19% of the physicians in the study, they cared for 57% of all of the patients in the study.

The researchers identified factors that were significantly associated with hospice enrollment. A higher incidence of comorbidities, older age, female gender, and white race were associated with hospice enrollment, and there were no clear geographic patterns. Patients who were treated by physicians who were predominantly linked to nonprofit hospitals also were significantly more likely to have enrolled in hospice, compared with patients treated by physicians associated with for-profit facilities. Patients receiving care from oncologists were more likely to be enrolled in hospice when compared to internists, family practitioners, and other specialties. The researchers concluded 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 data suggest that it is the physician’s characteristics that is the strongest predictor of whether a patient will be referred to hospice care, outweighing other known drivers, such as geographic location, patient’s age, race, sex, and comorbidities.


Obermeyer A, Powers BW, Makar M, et al. Physician characteristics strongly predict patient enrollment in hospice. Health Aff. 2015;34(6):993-1000.
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