In general, health care expenses and intensity of care varies for Medicare patients receiving chronic kidney dialysis during the last year of their life. One thing that does not vary, however, is their lack of access to hospice care, a new study has found.

As part of the study, published June 4 in the journal Health Affairs, researchers analyzed data from a national registry of end-stage renal disease, reviewing records from nearly 640,000 patients ages 18 to 100 who had died between 2000 and 2014. Using a statistical technique called trajectory modeling with total Medicare Parts A and B costs as the differentiating measure, researchers discovered four distinct groups among the patients: those who had escalating spending, those who had relatively low spending, those who had moderate spending and those who had persistently high spending.

In all groups, fewer than one in four patients enrolled in hospice, far lower than the roughly 50% hospice-enrollment rate for Medicare’s overall population.

“What was striking is that, despite the marked heterogeneity across the groups—in spending, the use of acute and subacute care, and patient characteristics—it made little difference to whether patients were enrolled in hospice and how long they received hospice services,” Ann O’Hare, lead author of the study and a professor of medicine at the University of Washington School of Medicine, said in a statement.

Hospice Care—covered by Medicare, Medicaid and most private insurers—is a benefit available to individuals with a life expectancy of six months or less. Medicare does not currently pay for dialysis treatment and hospice at the same time, which often means dialysis patients utilize hospice services either too late or not at all.

Nationally, about 20% of Medicare patients with end-stage renal disease use hospice prior to death.

Written by Robert Holly