Hospice Use Improves End-of-Life Care, Reduces Costs for Medicare Beneficiaries

Hospice enrollment was associated with lower total health care costs for the last 3 days to 3 months of life among community-dwelling Medicare beneficiaries, according to data published in JAMA Health Forum.

With a lack of knowledge on the extent to which hospice saves money across all payers including whether it shifts costs to family, researchers worked to determine the association between total health care costs and family out-of-pocket spending with hospice use.

Data of health care spending in the last 6 months of life between 2002 and 2018 was taken from the nationally representative Medicare Current Beneficiary Survey.

Researchers utilized covariate balancing propensity scores to compare study participants who did not use hospice (n=3351) and those who did (n=2113).

For this study, 5464 decedents were included with a mean age of 78.7 years, 48% female, and 38% enrolled with hospice.

“Total health care expenditures were lower for those who used hospice compared with propensity score weighted nonhospice control participants for the last 3 days of life ($2813 lower; 95% CI, $2396-$3230); last week of life ($6806 lower; 95% CI, $6261-$7350); last 2 weeks of life ($8785 lower; 95% CI, $7971-$9600); last month of life ($11 747 lower; 95% CI, $10 072-$13 422); and last 3 months of life ($10 908 lower; 95% CI, $7283-$14 533),” wrote study authors.

“Family out-of-pocket expenditures were lower for hospice enrollees in the last 3 days of life ($71; 95% CI, $43-$100); last week of life ($216; 95% CI, $175-$256); last 2 weeks of life ($265; 95% CI, $149-$382); and last month of life ($670; 95% CI, $530-$811) compared with those who did not use hospice.”

Reductions in inpatient care were associated with health care savings, noted researchers.

“The findings of this cohort study suggest that hospice use is an example of a health care model that demonstrates both components of the value proposition: it improves the quality of end-of-life care and is associated with lower health care costs,” concluded authors.

Reference:
Aldridge MD, Moreno J, McKendrick K, Li L, Brody A, May P. Association between hospice enrollment and total health care costs for insurers and families, 2002-2018. JAMA Health Forum. 2022;3(2):e215104. doi:10.1001/jamahealthforum.2021.5104