Hospice enrollment saves Medicare dollars and improves quality of care for Medicare beneficiaries among many enrollment periods, even shorter ones, according to new research published in the March issue of Health Affairs.
Previously, the Medicare hospice benefit has been seen as producing savings only for patients enrolled 53-105 days before death, but new data shows even higher savings among shorter, more common enrollment periods.
Hospice patients were found to have significantly lower rates of hospital and intensive care use, hospital readmissions, and in-hopsital death among enrollees compared to non-hospice patients among all of the most common enrollment periods (1 to 7 days, 8 to 14 days, 15 to 30 days, and 53 to 105 days), according to researchers from the Brookdale Department of Geriatrics and Palliative Medicine at the Icahn School of Medicine at Mt. Sinai.
Additionally, savings for Medicare can be found among both cancer patients and non-cancer patients, and the savings appear to grow in correlation to the length of time spent in hospice enrollment with the observed study period of one to 105 days.
“If 1,000 additional beneficiaries enrolled in hospice 15 to 30 days prior to death, Medicare could save more than $6.4 million,” the researchers said in the study, suggesting that investment in the Medicare Hospice Benefit could translate into overall savings for the program. “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.”
A previous 2007 study from Duke University also showed that hospice care saves dollars for the Medicare system.
“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 (NHPCO) in a statement.
More than 44% of Americans toward the ends of their lives were cared for by hospice in 2011, according to the NHPCO. Of those, 84% of the hospice care was paid for through Medicare’s hospice benefit.
The researchers questioned recent efforts to aggressively inspect or investigate the practice of enrolling patients with late-stage diseases but unpredictable prognoses as an effort to contain Medicare hospice spending.
“Our finding suggest these efforts maybe misguided,” they wrote. “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.”
Access the study at Health Affairs.
Written by Alyssa Gerace