Impact of Hospice on Spending and Utilization Among Patients With Lung Cancer in Medicare.
Yamini Kalidindi, Joel Segel, Jeah Jung
PMID 31564110WHAT IT FOUND
Lung cancer patients who used hospice had lower spending and less aggressive care in their final month.
They were significantly less likely to be hospitalized or visit the emergency room, and received fewer chemotherapy and radiation sessions compared to non-users.
Key findings
01In the final month of life, hospice users had significantly lower adjusted Medicare spending ($16,907) compared to non-users ($26,906).
02Hospice users were significantly less likely to experience hospitalization (54% vs 80%) and emergency department visits (15% vs 22%) in the last month of life.
03Savings varied by enrollment duration; patients enrolled for 30-60 days had larger savings ($15,689 lower) than those enrolled for less than 7 days ($3,816 lower).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study lacked data on cancer stage, which influences both the decision to enroll in hospice and spending patterns, though researchers attempted to control for metastasis. Propensity score matching cannot account for unobserved differences between patients who choose hospice and those who do not, such as personal preferences or family support. The analysis did not include home-health costs, which may affect the total financial picture. The study measured spending and utilization, not quality of life or patient satisfaction outcomes.
The easy way to misread this
Do not interpret the lower spending and reduced acute care utilization as proof that hospice improves quality of life. The study measured financial and service data, not patient outcomes like pain control or satisfaction, and the reduction in aggressive treatments may reflect patient choice rather than a universal benefit.