Hospice Enrollment Saves Money For Medicare And Improves Care Quality Across A Number Of Different Lengths-Of-Stay

Abstract

Despite its demonstrated potential to both improve quality of care and lower costs, the Medicare hospice benefit has been seen as producing savings only for patients enrolled 53–105 days before death. Using data from the Health and Retirement Study, 2002–08, and individual Medicare claims, and overcoming limitations of previous work, we found $2,561 in savings to Medicare for each patient enrolled in hospice 53–105 days before death, compared to a matched, nonhospice control. Even higher savings were seen, however, with more common, shorter enrollment periods: $2,650, $5,040, and $6,430 per patient enrolled 1–7, 8–14, and 15–30 days prior to death, respectively. Within all periods examined, hospice patients also had significantly lower rates of hospital service use and in-hospital death than matched controls. Instead of attempting to limit Medicare hospice participation, the Centers for Medicare and Medicaid Services should focus on ensuring the timely enrollment of qualified patients who desire the benefit.

Temporal Association between Home Nursing and Hospital Costs at End of Life in Three Provinces

“…Unlike the U.S. studies, which found cost savings for long enrolment periods of 105 days 22,23 , the cost savings in our study were observed mostly during the last month of life. Our findings might be more generalizable to countries with a similar single-payer health care system, such as the European Union, the United Kingdom, or Australia.…”

“…Related studies examining home-based palliative care programs delivered within the U.S. Medicare hospice benefit also demonstrated cost savings [22][23][24] . Those studies used propensity score matching to identify appropriate control groups; however, they did not differentiate the particular effect of palliative home nursing services, and results were specific to the United States, which requires a beneficiary to forego acute-care services before accessing the hospice benefit 25 .…”

NCCN Guidelines Insights: Palliative Care, Version 2.2017

“…48 Multiple additional studies have produced similar findings with regard to hospitalizations, emergency department visits, noncancer clinic visits, and cost savings. [49][50][51] Importantly, hospice care is also linked to important improvements in patient and caregiver QOL. However, despite the 6-month prognosis eligibility, the median LOS for hospice patients in 2014 was just 17.4 days.…”

Research Methods Priorities in Geriatric Palliative Medicine

“…One such method for reducing the effects of selection bias on the estimation of treatment effects on outcomes in observational studies that is gaining popularity in palliative medicine and aging research is propensity score matching. [6][7][8] Recent studies across a range of topics have employed propensity scores to more closely match intervention subjects (or ''cases'') with control subjects, including studies evaluating (1) the impact of palliative care consultation teams on hospital costs, [9][10][11] (2) family perceptions of care from palliative care consult teams versus inpatient units, 12 (3) the impact of hospice enrollment on Medicare expenditures, 13 and (4) the impact of feeding tubes on pressure ulcers in a cohort of nursing home residents. 14 In short, a propensity score is a summary measure of multiple characteristics (usually patient characteristics) associated with both the study intervention and outcome of interest.…”