Research out of Mt. Sinai shows hospice patients have lower Medicare
costs, reduced use of hospital services, and that hospice can improve care
quality
New research published in the March issue
of Health Affairs found that hospice
enrollment saves money for Medicare and improves care quality for Medicare
beneficiaries with a number of different lengths of services.
The National Hospice and Palliative Care Organization
applauds this study that adds to a growing body of research demonstrating the
value of hospice care both in terms of high quality and cost savings.
Led by Amy S. Kelley, MD, MSHS, from the Brookdale
Department of Geriatrics and Palliative Medicine at the Icahn School of
Medicine at Mt. Sinai, researchers looked at the most common hospice enrollment
periods: 1 to 7 days, 8 to 14 days, 15 to 30 days, and 53 to 105 days. Within
all enrollment periods studied, hospice patients had significantly lower rates
of hospital and intensive care use, hospital readmissions, and in-hospital
death when compared to the matched non-hospice patients.
The study reveals that savings to Medicare are present for
both cancer patients and non-cancer patients. Moreover, these savings appear to
grow as the period of hospice enrollment lengthens with the observed study
period of one to 105 days.
Study authors suggest that investment in the Medicare Hospice
Benefit translates into savings overall for the Medicare system. “If 1,000
additional beneficiaries enrolled in hospice 15 to 30 days prior to death,
Medicare could save more than $6.4 million,” they note.
Furthermore, the authors write, “In addition, reductions in the use of hospital
services at the end of life both contribute to these savings and potentially
improve quality of care and patients’ quality of life.”
“We know that hospice
care addresses so many critical issues involving quality of care at the end of
life and that hospice brings dignity and compassion when they are needed most.
This new study reaffirms other reasons why hospice is the best solution for
caring for the dying in a way that provides patient-centered care and is cost
effective for the Medicare system,” said J. Donald Schumacher, president and
CEO of the National Hospice and Palliative Care Organization.
This study builds on the valuable work of the 2007
Duke University study by providing further proof that hospice care saves
the federal Medicare system money.
Added Schumacher, “For many years, hospice professionals
have known through firsthand experience, that the interdisciplinary care they
provide to patients and family caregivers coping with life-limiting illness
significantly improves quality of life and allows people to focus on living as
fully as possible even as life draws to a close. Now the broader healthcare
community, regulators and legislators understand more fully the many benefits
of hospice care.”
NHPCO reports that more than 44 percent of dying Americans
were cared for by hospice in 2011. Among these patients, 84 percent of hospice
care was paid for through the Medicare hospice benefit.
“We have an example of a care delivery model that not only
scores high in patient and family satisfaction, reduces hospital services, and
promotes the dignity of every person cared for but also can be cost effective
with regards to federal spending,” Schumacher noted.
Based on the study’s findings, the researchers questioned
recent aggressive efforts, including the Office of the Inspector General’s
investigation of hospices that enroll patients with late-stage diseases but
unpredictable prognoses.
“Our finding suggest these efforts maybe misguided,” write the researchers.
“Rather than working to reduce Medicare hospice expenditures and creating a
regulatory environment that discourages continued growth in hospice enrollment,
CMS should focus on ensuring that patient’s preferences are elicited earlier in
the course of their disease and those who want hospice care receive timely
referral.”
NHPCO has consistently supported earlier discussions of care options once a
person receives a diagnosis of a serious illness.
NHPCO and Hospice Action Network offer some key messaging points about the study; additionally, a link to the study is available on the HAN website.
