Performance improvement program for reducing home health care costs in hospice.

Background The healthcare system in the United States has been plagued by service limitations imposed by financial constraints. Hospice is no exception, and hospice providers must continually seek out ways to provide cost-effective care. In response to this environment, many hospices are making a concerted effort to find efficient, low expenditure approaches to providing care without compromising the quality of that care.1 At Delaware Hospice, Inc., 65% of our patients require home health aide (HHA) care. We use a combination of employed and contracted HHAs to meet this demand. However, an initial review of expenditures showed that our contracted home health aide expenses were consistently over per patient day (PPD) budget by more than 25%, with costs escalating every month. By year-end, our expenditures were more than 30% over PPD budget, without an increase in the percent of patients receiving HHA services.