Medicare Cost at End of Life.
Ian Duncan, Tamim Ahmed, Henry Dove and 1 others
PMID 30884954WHAT IT FOUND
Medicare spending rises sharply in the final months of life, especially for people who die in hospital.
The paper models lower costs with earlier hospice or palliative care, but it does not test patient outcomes.
Key findings
01For members who died in 2015, Medicare spending was US$2.5 billion of US$19.0 billion, or 13.4%; after adding their final 12 months and applying the authors' adjustment, the share rose to 21%.
02Average Medicare spending per decedent per month was higher in the last 90 days before death than in the last 180 days, and the highest spending occurred in acute hospitals.
03The analysis models possible savings from hospice admission within 90 days of death because hospice reimbursement rates are lower than hospital costs for people who die in hospital.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study analyzes Medicare claims and modeled cost savings, so it does not show that earlier hospice or palliative care improves patient or family outcomes. The share of Medicare spending attributed to end-of-life care changes depending on the method used, so the paper's estimate is not a fixed fact. The claims file does not include outpatient pharmaceutical data, so total spending is not fully captured. The analysis excludes some Medicare Advantage members and members with short eligibility, so it may not represent all Medicare beneficiaries. Place of death is assigned from the last service date, which may not capture the full care pathway.
Declared interests
The authors declared no potential conflicts of interest and received no financial support.
The easy way to misread this
Do not read the cost figures as proof that earlier hospice improves patient outcomes. This paper models Medicare spending and reimbursement differences; it does not test a hospice or palliative care intervention in patients.