End-of-life care is often fingered as a principal culprit in high health spending, with much of it being for futile and wasteful care that is contrary to patient wishes. One alternative for people with terminal illnesses in Medicare is hospice care. A study carried by the Journal of the American Medical Association examines utilization and cost for patients treated in a hospice versus those not in hospice. (JAMA Article) The patients were fee-for-service Medicare beneficiaries with cancers that had a very poor prognosis. Cancer patients are the single largest group of hospice users. The analysis examined a large, adjusted and matched sample of cancer patients in each group. The non-hospice group had higher rates of hospitalization, use of intensive care and invasive procedures and 74% died in a hospital or skilled nursing facility, compared to only 14% of hospice patients. Toward the very end of their lives, costs for hospice users were an average $556 per day versus $1706 for non-hospice patients. In the last year of life, mean costs for hospice patients were $62,819 and for non-hospice users, $71,517.
A number of CMS policies likely limit hospice use, including not paying for end-of-life care discussions, requiring beneficiaries to renounce curative measures and cracking down on length-of-stay. This is stupid to say the least, but about what we would expect from a politically driven, government-run health plan. Hospice care is more consistent with many people’s wishes for end-of-life care and provides a higher quality of life for people who receive it. It is also clear that it saves money, so while this won’t happen any time soon, CMS should at a minimum remove its policies inhibiting hospice use, and really should enact ones that encourage it.