Medicare beneficiaries who have poor-prognosis cancers and received hospice care had significantly lower rates of hospitalization, intensive care unit (ICU) admissions and invasive procedures at the end of life, along with significantly lower healthcare expenditures during the last year of life, according to a study in the Nov. 12 issue of JAMA.
Using data from Medicare beneficiaries with poor-prognosis cancers (for instance, brain, pancreatic and metastatic malignancies), Ziad Obermeyer, MD, MPhil, of Brigham and Women's Hospital and Harvard Medical School, Boston, and colleagues matched those enrolled in hospice before death with those who died without hospice care and compared utilization and costs at the end of life. The study included a nationally representative 20 percent sample of Medicare fee-for-service beneficiaries who died in 2011.
Among 86,851 people with poor-prognosis cancers, 51,924 (60 percent) entered hospice before death. Matching patients/residents based on various criteria produced a hospice and nonhospice group, each with 18,165 patients/residents. Median hospice duration was 11 days.
The researchers found that nonhospice beneficiaries had significantly greater healthcare utilization, largely for acute conditions not directly related to cancer and higher overall costs. Rates of hospitalizations (65 percent versus 42 percent), ICU admissions (36 percent versus 15 percent), invasive procedures (51 percent versus 27 percent) and death in a hospital or nursing facility (74 percent versus 14 percent) were higher for nonhospice beneficiaries compared with hospice patients. 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 write.
This work was supported by grants from the National Institutes of Health, the National Cancer Institute and the Agency for Healthcare Research and Quality.
In a related commentary, Joan M. Teno, MD, MS, and Pedro L. Gozalo, PhD, of the Brown University School of Public Health, Providence, RI, write: “As financial incentives change in the U.S. healthcare system, valid measures of care quality are increasingly important for ensuring transparency and accountability. 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. 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.”
Source: JAMA press release