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Regarding Great News

Dr. Dillinger,
Thank you for posting. I believe I have read some articles saying that patients covered under Medicare use more than 33% and some use up to 40% of their total care usage/cost to Medicare during their last 6-12 of life. I do not recall the source, but you have sparked my interest and I’ll work on finding current data. First I’ll look to Centers for Medicare and Medicaid Services data, unless you wish to guide me elsewere. Thanks again

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  • O. David Dellinger III MD

    CBS News in its story “The Cost of Dying” places the expenditures of healthcare in the last two months of life at $50B.  Not sure where they get this from.
    I agree with VJ Periyakoil; the Dartmouth Atlas Report is well worth reading. 
    Another article that addresses this is from the Journal of Pain and Symptom Management, Vol 28, Number 3, September 2004.  While a little dated, it does a good job discussing the topic and points out some of the difficulties of measuring end of life costs. 
    The studies that seem to be most cited showing higher costs are a study by Campbell et al in Annals of Internal Medicine in 2004 and two studies from 2002 (Moon and Boccuti, and Hogan).  In general, these and similar studies show lower costs for cancer patients and for patients with shorter hospice stays, while cost savings appear to diminish with longer stays.
    Finally, a study by Candy et al in the International Journal of Nursing Studies (Jan 2011, 48 (1)) shows decreased cost and increased satisfaction with hospice care as opposed to routine care.
    While many articles have been written on the topic, I’m not sure I would call any of them definitive.
    I do agree that not everyone in Hospice care should be there.  I have certainly seen patients who were simply using hospice as a way to get services that would otherwise not be available to them.  Hospices also seem to favor patients with dementia as they are viewed as ‘low cost’ patients.  As a medical director, I see part of my job as insuring our services go to those who need and want it, not those who we can justify on paper but who are otherwise not a good fit or are simply playing the system.  In this way I hope we can live up to the promise of providing better care more cheaply.

  • R Moscola

    I have read that hte cost for Cancer care may decrease with the use of hospice but the cost for care of other terminal illnesses actually increases. I am finding that people are choosing to use the hospice benefits when they really should be seeking Assisted Living or Long Term Care placement.

  • VJ Periyakoil

    Jenny and Jame: A significant portion ( 25%) all Medicare spending goes to pay for the care of beneficiaries in their last year of life. Also, the growth in Medicare spending in recent decades is the result of the high cost of treating chronic diseases. This is a lose-lose situation as we subject seriously and terminally ill patients ( and their families) to burdensome procedures that erode their quality of life, their dignity as well as their often meager fiscal resources. Costly illnesses trigger about half of all personal bankruptcies in the US, and most of those who go bankrupt because of medical problems have health insurance, according to findings from a Harvard University Study. Finally, hospitals also lose out when they have a lot of lengthy admissions and expected deaths for chronic and terminal illnesses. Bottomline is that the patient and family as well as the hospitals suffer and this has lasting repurcussions on the national economy.I highly recommend reading the recent Dartmouth Atlas report ” Trends and Variation in End-of-Life Care  for Medicare Beneficiaries with Severe Chronic Illness” Happy to send you the document if you need itVJ PeriyakoilTwitter handle: @palliator 

  • Jame Restau

    I am sure that I have read that the last year that use 33%. I just can’t find it anywhere.

  • Judyperes

    You might find the recent MedPac Data book helpful.  In general, about 27% of Medicare outlays are for the last year of life … a percentage that has been relatively stable for the past 25 years.

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