Hospice enrollment policy may lead to under use NEW YORK, Jan. 24 (UPI) -- The enrollment policies of U.S. hospices may contribute to the under use of the services of the end-of-life care, U.S. researchers say. Melissa D. Aldridge Carlson of Mount Sinai School of Medicine in New York; Colleen L. Barry of The Johns Hopkins Bloomberg School of Public Health in Baltimore; Emily J. Cherlin of Yale University School of Public Health in New Haven, Conn.; Ruth McCorkle of the Yale School of Nursing; and Elizabeth H. Bradley of Yale University, director of the Yale Global Health Initiative, said U.S. hospice is growing, but little is known about barriers that terminally ill patients may face when trying to access hospice care. This study involves the first national survey of the enrollment policies of 591 U.S. hospices. The survey revealed 78 percent of hospices had at least one enrollment policy that may restrict access to care for patients with potentially high-cost medical care needs, such as chemotherapy or total parenteral nutrition -- feeding a person intravenously. Smaller hospices, for-profit hospices and hospices in certain regions of the country consistently reported more limited enrollment policies, the researchers said. "We observe that hospice providers' own enrollment decisions may be an important contributor to previously observed under use of hospice by patients and families," the researchers said in the study. Policy changes that should be considered include increasing the Medicare hospice per diem rate for patients with complex needs, which could enable more hospices to expand enrollment. The findings were published in the journal Health Affairs.