End-of-life care accounts for a good deal of total health care spending and Medicare obviously pays for a lot of that end-of-life care. A research letter in JAMA Internal Medicine analyzes whether the slowdown in Medicare fee-for-service spending is in part due to any reduction in the costs of end-of-life care. (JAMA Int. Med. Article) The authors used constant dollar spending data from 2004 to 2014 to evaluate the spending on people who died in the two years prior to death. Per beneficiary Medicare expenditures went from $9119 in 2004 to $10458 in 2009 to $9589 in 2014. Much of the recent decline is attributable to lower per capita spending on decedents and this decrease is driven by lower intensity of service. Inpatient, physician and home health service cost reductions were the major sources of lower spending, with inpatient making a particularly notable contribution, suggesting that more people are avoiding intensive hospital stays when enduring a critical illness near the end-of-life. Among all beneficiaries, per capita home health spending rose during the period, while it stayed relatively flat for decedents, indicating that this troublesome category was better managed for those near death. Hospital outpatient spending was also more restrained for decedents than for the total population. The study suggests that efforts to rein in use of expensive care in futile situations may be having an effect.
