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Dartmouth Atlas: Costs Rise for Medicare Patients at End of Life

John Commins, for HealthLeaders Media, April 13, 2011

Chronically ill Medicare patients spent fewer days in the hospital and received more hospice care in 2007 than they did in 2003. Patients who were hospitalized, however, got more aggressive, intensive, and costly care, according to a new Dartmouth Atlas Project report on end-of-life care.

The study -- Trends and Variation in End-of-Life Care for Medicare Beneficiaries with Severe Chronic Illness – was released Tuesday and found that Medicare patients diagnosed with severe chronic illness were less likely to die in a hospital and more likely to receive hospice care. They also had many more visits from physicians, particularly medical specialists, and spent more days in ICUs.

"In addition to its effects on patients' quality of life, unnecessarily aggressive care carries a high

financial cost. About one-fourth of all Medicare spending goes to pay for the care of patients in their last year of life, and much of the growth in Medicare spending is the result of the high cost of treating chronic disease," said David C. Goodman, MD, lead author of the report, in a media release.

"It may be possible to reduce spending, while also improving the quality of care, by ensuring that patient preferences are more closely followed," said Goodman, a co-principal investigator for the Dartmouth Atlas Project, and director of the Center for Health Policy Research at the Dartmouth Institute for Health Policy and Clinical Practice.

The report documents trends from 2003 to 2007 in the use of medical resources to treat Medicare patients at the end of life at hospital referral regions and at 94 academic medical centers.

Geography continues to play a huge role, the report found, noting that care patients received in the months before they died depended largely on where they lived, and widespread variations persist. Even at academic medical centers, patients' end-of-life experiences differ greatly. Most academic medical centers substantially changed the intensity of the end-of-life care they provided from 2003 to 2007, but not in the same direction. Some provided more. Some provided less.

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