Medicare Costs Rise at End of Life
Medicare Costs Rise at End of Life, but Hospital Days Decline, Report Says
Medicare spending for chronically ill patients at
the end of life increased more than 15% from 2007 to 2010, but these
patients spent fewer days in the hospital and were more likely to be
enrolled in hospice care, according to a report from the Dartmouth Atlas
Project, based in Lebanon, New Hampshire.
"These changes reflect the preferences of most patients to spend their last weeks and months in a homelike environment whenever possible, avoiding procedures that have little chance of improving the quality or length of their lives," concludes the report, titled Tracking Improvement in the Care of Chronically Ill Patients: A Dartmouth Atlas Brief on Medicare Beneficiaries .
Patients in 2010 also were less likely to die in the hospital, more likely to see more than 10 physicians during the last 6 months of life, and just as likely to spend time in intensive care units (ICUs), with no change from 2007 to 2010, the report said.
The research looked at the last 2 years of Medicare claims records of 1.1 million patients who died in 2010.
"The growing use of hospice care and decrease in hospital use at the end of life are promising trends that may reflect attempts to provide care that aligns more closely with patients' preferences," David C. Goodman, MD, co–principal investigator for the Dartmouth Atlas Project, said in a press release. Progress varies, however, across regions and hospitals. "Where patients live and receive care are some of the most significant factors in how they spend their last years."
Average spending per chronically ill Medicare patient in the last 2 years of life increased from $60,694 in 2007 to $69,947 in 2010. Spending rates in 2010 varied from a high of $112,263 in Los Angeles to a low of $46,563 in Minot, North Dakota. Bloomington, Illinois, was the only region to show a decrease in spending per patient, from $57,802 in 2007 to $53,674 in 2010, the report found.
The percentage of deaths of chronically ill patients at hospitals declined from 28.1% in 2007 to 25% in 2010. The highest death rates in 2010 were in regions in and around New York City, including Manhattan (43.7%). Medicare patients were far less likely to die in a hospital in Dubuque, Iowa (15.2%) or Fort Lauderdale, Florida (17%).
Between 2007 and 2010, the use of hospital services in the last 6 months of life declined from 10.9 to 9.9 days per patient. The percentage of patients enrolled in hospice increased from 41.9% to 47.5%, and the average number of hospice days increased from 18.3 to 21 days. The number of days spent in ICUs was unchanged.
Although overall physician visits were stable, 42% of patients dying
in 2010 saw 10 or more different physicians in their last 6 months of
life compared with 36.1% in 2007. Patients in eastern Long Island, New
York, received the most intensive care, with 62.3% seeing 10 or more
physicians. Regions with low rates included Idaho Falls, Idaho (14.5%),
and Grand Junction, Colorado (17.7%).
"Studies show that more spending, more days in the hospital, and more physician visits are not always associated with better outcomes or with the care that patients want," the report concludes. "Less intensive and expensive care can both save money and improve quality, satisfaction, and outcomes for many Medicare beneficiaries."
Full data from the report can be downloaded on the Dartmouth Atlas Project Web site.
The Dartmouth Atlas Project is located at the Dartmouth Institute for Health Policy & Clinical Practice and is principally funded by the Robert Wood Johnson Foundation, with support from a consortium of funders that includes the National Institute of Aging, the WellPoint Foundation, the United Health Foundation, and the California Healthcare Foundation.
"These changes reflect the preferences of most patients to spend their last weeks and months in a homelike environment whenever possible, avoiding procedures that have little chance of improving the quality or length of their lives," concludes the report, titled Tracking Improvement in the Care of Chronically Ill Patients: A Dartmouth Atlas Brief on Medicare Beneficiaries .
Patients in 2010 also were less likely to die in the hospital, more likely to see more than 10 physicians during the last 6 months of life, and just as likely to spend time in intensive care units (ICUs), with no change from 2007 to 2010, the report said.
The research looked at the last 2 years of Medicare claims records of 1.1 million patients who died in 2010.
"The growing use of hospice care and decrease in hospital use at the end of life are promising trends that may reflect attempts to provide care that aligns more closely with patients' preferences," David C. Goodman, MD, co–principal investigator for the Dartmouth Atlas Project, said in a press release. Progress varies, however, across regions and hospitals. "Where patients live and receive care are some of the most significant factors in how they spend their last years."
Average spending per chronically ill Medicare patient in the last 2 years of life increased from $60,694 in 2007 to $69,947 in 2010. Spending rates in 2010 varied from a high of $112,263 in Los Angeles to a low of $46,563 in Minot, North Dakota. Bloomington, Illinois, was the only region to show a decrease in spending per patient, from $57,802 in 2007 to $53,674 in 2010, the report found.
The percentage of deaths of chronically ill patients at hospitals declined from 28.1% in 2007 to 25% in 2010. The highest death rates in 2010 were in regions in and around New York City, including Manhattan (43.7%). Medicare patients were far less likely to die in a hospital in Dubuque, Iowa (15.2%) or Fort Lauderdale, Florida (17%).
Between 2007 and 2010, the use of hospital services in the last 6 months of life declined from 10.9 to 9.9 days per patient. The percentage of patients enrolled in hospice increased from 41.9% to 47.5%, and the average number of hospice days increased from 18.3 to 21 days. The number of days spent in ICUs was unchanged.
"Studies show that more spending, more days in the hospital, and more physician visits are not always associated with better outcomes or with the care that patients want," the report concludes. "Less intensive and expensive care can both save money and improve quality, satisfaction, and outcomes for many Medicare beneficiaries."
Full data from the report can be downloaded on the Dartmouth Atlas Project Web site.
The Dartmouth Atlas Project is located at the Dartmouth Institute for Health Policy & Clinical Practice and is principally funded by the Robert Wood Johnson Foundation, with support from a consortium of funders that includes the National Institute of Aging, the WellPoint Foundation, the United Health Foundation, and the California Healthcare Foundation.
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