End-of-life care accounts for a significant proportion of all health spending. Extensive efforts have been made to minimize that spending, which is often futile. A Research Letter in JAMA Internal Medicine analyzes recent trends in Medicare spending in regard to end-of-life care. (JAMA Int. Med. Art.) The researchers used Medicare fee-for-service data from 2004 to 2014 and looked at total average annual spending for all beneficiaries and for beneficiaries who had chronic conditions and died, comparing spending for those who continued to live and those who died. Spending in the two years prior to death was considered end-of-life spending; that seems like a long period. Over 4% of Medicare beneficiaries die each year. Overall per capita Medicare FFS expenditures per beneficiary per year increased between 2004 and 2009 from $9119 to $10,458; and decreased from 2009 to 2014 to $9589; which may reflect the influx of younger baby-boomers. Changes in practice intensity (the number of services for an episode) increased up to 2009, but then decreased. Most of the decrease, 55%, was attributable to decedents, even though they were only a little over 4% of all beneficiaries. The changes in spending occurred among inpatient, home health and physician services. The results suggest that in fact there have been significant results from efforts to control costs and utilization near end-of-life, which is good news for Medicare, which bears most of those costs. It would be interesting to see a comparison with Medicare Advantage, where there is even more incentive to manage spending carefully, and to ascertain if there are some spillover effects, especially among doctors with large MA patient pools.
