In a recent study, Gunjan Sharma, MS, from The US Oncology Network (The Network) in Woodlands, Texas, and colleagues examined the burden that patients and caregivers face with end-of-life (EOL) care costs. EOL care is necessary for patients as it reduces the need for unnecessary health care interventions and improves the overall patient experience, including considerations around where the patient wants to die and the type of EOL care they receive. However, the overall impact that hospice care has on total cost of care (TCOC) in episodic value-based care (VBC) models is unknown. During the 6-year period of Medicare’s VBC program, the Oncology Care Model (OCM), practices were encouraged to transform care to ensure a better patient experience. Sharma studied the overall impact that timely hospice care had on TCOC, EOL costs, and the patient/caregiver experience. 

Sharma and colleagues analyzed the episode-level data from patients who died during the years that the OCM model was active in July 2016 to June 2022. A total of 15 practices within The Network were analyzed. Patients that experienced episodes with or without hospice were also evaluated by their utilization and overall experience outcomes. 

The researchers found that within the 26,074 decedents in OCM’s 6-year period, 55% were enrolled in hospice for 3 or more days and 45% were not enrolled in hospice or were enrolled for less than 3 days. The mean TCOC for hospice episodes ($41,297, n = 14,240) was significantly lower than the no hospice episodes ($47,601, n = 11,834). They also found that patients’ median duration of hospice stay was about 9 days. Patients in the no hospice group had significantly higher (2x) median duration for ICU and inpatient costs. About 44% of no hospice patients died in the hospital or in an ICU, while 97% of hospice patients died in their homes or in a hospice facility. 

“Timely and proactive enrollment in hospice and coordinated EOL care can improve patient experience, but also reduce EOL costs for the health care system and patients,” wrote the authors. 

In conclusion, hospice enrollment improved patients’ overall quality of end-of-life care and lowered TCOC in comparison to patients that did not enroll in hospice care under the 6 years of OCM. The researchers also noted that hospice patients who were enrolled for 3 or more days had statistically significant lower EOL care expenses, less acute care interventions, and died in their home or a hospice facility. 
 

Sharma G, Deepak D, Neeb J, et al. The impact of hospice on end-of-life expenditures and total cost of care in episodic value-based care models at a community oncology network. Presented at: the 2023 ASCO Quality Care Symposium; October 27-28, 2023; Boston, MA, and virtual; Abstract 228.