At Hershey Medical Center in Hershey, PA, "there was a "26% reduction in ICU days over a three year period and an 18% reduction in physician visits. This does not happen by accident," Goodman says.
More disappointing, however, was the report's failure to find a decline in cost of care at the end of life. The institute published its first end-of-life care report on 2007 care practices in 2010. Since then, costs have risen.
The average spending for a terminally ill Medicare patient during the last two years of life increased 15.2%, from $60,694 in 2007 to $69,947 in 2010. Those costs were not adjusted for inflation, but the increase was much higher than the consumer price index of 5.2%, Goodman says.
"Whether we're beating the cost of living index or lagging behind, the norm is what's killing us," he explains. "These are unsustainable increases in Medicare program payments." More important, he says, is that there's strong evidence that lengthy end-of-life stays in the hospital and "receiving uncomfortable procedures" are not what patients want.
"The important takeaway," from the latest report, Goodman says, is that hospitals that are spending high amounts on end-of-life care "need to look very closely at the care they deliver. There's going to be expectations that all places, particularly those that are spending a lot more money without being able to demonstrate comparable better outcomes, will have to explain that. And when there are opportunities to improve care, they will need to improve care."