Hospice Care Reduces Hospitalizations, Healthcare Expenditures for Medicare Patients

Hospice care for Medicare patients resulted in lower hospitalization rates and lower healthcare expenditures during the last year of life, according to a study published the November 12 issue of JAMA.

These same Medicare patients, with a poor

prognosis

cancer

, also had significantly lower rates of intensive care unit admissions and invasive procedures at the end of life. Ziad Obermeyer, MD, MPhil, of Brigham and Women’s Hospital and Harvard Medical School, and colleagues, used data from Medicare beneficiaries with poor prognosis cancer, such as brain, pancreatic, or metastatic malignancies.

The researchers matched those enrolled in hospice before death to those who died without hospice care. Of the 86,851 patients with poor-prognosis cancer, 60% entered hospice before death.

Nonhospice care beneficiaries had significantly greater healthcare utilization, largely for acute conditions not directly related to the cancer. Nonhospice care patients also had higher overall costs. Overall, costs during the last year of life were $62,819 for hospice beneficiaries and $71,517 for nonhospice beneficiaries.

“Our findings highlight the potential importance of frank discussions between physicians and patients about the realities of care at the end of life, an issue of particular importance as the Medicare administration weighs decisions around reimbursing physicians for advance care planning,” the authors wrote.

Compared with nonhospice beneficiaries, those patients who entered hospice care had lower rates of hospitalizations (65% vs 41%), intensive care unit admissions (36% vs 15%), invasive procedures (51% vs 27%), and death in a hospital or nursing facility (74% vs 14%).

In an accompanying editorial in JAMA, Joan M. Teno, MD, MS, and Pedro L. Gonzalo, PhD, of the Brown University School of Public Health, commented that valid measures of care quality are increasingly important as financial incentives change.

“Obermeyer and colleagues assessed hospitalization rates, intensive care admissions, and invasive procedures, but additional measures must have evidence of their ability to discriminate the quality of care and must be responsive to change, easy to understand, and actionable,” they wrote. “This will involve investing public dollars in the ‘quality’ of quality measures and their dissemination. If quality of care is not front and center, the momentum to improve end-of-life care in the United States could face a serious setback.”