Hospice news

Abstract

Research published in the September 2004 issue of the Journal of Pain and Symptom Management reports that patients enrolled in hospice care cost Medicare less. The study, “Medicare Cost in Matched Hospice and NonHospice Cohorts,” also revealed that hospice patients lived longer, on average, than similar patients who did not choose hospice care. Commissioned by the National Hospice and Palliative Care Organization (NHPCO) and conducted by the actuarial firm of Milliman, USA, the study’s goal was to identify cost differences between patients who elect and do not elect to receive Medicare-paid hospice benefits. According to the research, the majority of patients with 16 of the most common terminal diagnoses who choose hospice care cost Medicare less. Cost savings range from $1,115 for rectal cancer patients to $8,879 for congestive heart failure patients. Researchers also found that, on average, hospice patients lived longer. These life spans range from 20 days for patients with a diagnosis of gallbladder cancer to 69 days for those with breast cancer. “With almost 30 percent of Medicare costs going for all types of care delivered towards the end of life, an understanding of the cost benefits of hospice is important,” said J. Donald Schumacher, president and CEO of NHPCO. “However, discussions relating to costs should never cloud the most important issue— hospice provides the highest quality of compassionate care for patients and families.” A significant factor in this study is the unique methodology used to work towards eliminating selection bias. Selection bias has been a recognized problem in previous studies contrasting hospice versus nonhospice patients. Medicare health insurance claims and enrollment data were used to measure both costs and time until death, starting from narrowly defined dates. Indicative markers were identified that represented unambiguous points in the end stage of each disease. This study began tracking patients further upstream in a manner that researchers suggest addresses many selection bias concerns. The data source was Medicare health insurance claims and enrollment data from 5 percent Sample Beneficiary Standard Analytic Files for years 1998, 1999, and 2000. This 5 percent sample is created by the Centers for Medicare & Medicaid Services as a statistically representative, longitudinal data set. The research includes 8,700 patients who met the criteria for this study. The article points out that a period of at least two to three months of hospice care may be optimal from both a cost and clinical standpoint. (Source: NHPCO press release, September 21, 2004.)